Rheumatic heart disease is an endemic in developing countries. The most common valve affected is the mitral valve for which mitral valve replacement is done. Left Ventricle Function (LVEF) is used to measure the prognosis of patients after MVR. Patients with a good LVEF perform better with less morbidity and mortality in comparison to patients with low post-operative EF. Therefore, prediction of post-operative EF is mandatory in patient’s selection and post-operative management. Objective: To determine the effect of pre-operative left ventricular end-systolic dimension in predicting postoperative LV function in mitral valve replacement. Methods: A total of 100 patients with mitral valve replacement were selected for the research. The study was conducted at the cardiac surgery department of National Institute of Cardiovascular Diseases, Karachi from April 2022 to October 2022. Results: The mean age of patients was 37 ± 10 years, LVESD: 34.7 ± 8.4mm, LVEDD: 51.1 ± 9.1mm, PASP: 44 ± 11mmHg, and EF of 55 ± 9%. Patients having Left ventricular end-systolic dimension (LVESD)> 38 mm had a significant post-operative left ventricular dysfunction after mitral valve replacement than patients having a pre-operative LVESD < 38mm (p= 0.003). Moreover, patients having a pre-operative LV dysfunction (EF <55%) were more prone to post-operative LV dysfunction(p=0.02). However, pre-operative LVESD is a more sensitive predictor of post-operative LV dysfunction than pre-operative LVEF (0.003<0.02). Conclusion: Left Ventricular End-Systolic Dimension (LVESD) is a more sensitive parameter as compared to pre-operative LV ejection fraction (LVEF) in predicting post-operative LV ejection fraction (LVEF) after mitral valve replacement (MVR).

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The cardiac surgery procedures are associated with a release of enzyme troponin from the heart muscles. These troponin levels can be used to predict the post-operative outcomes. Objective: To find out the relationship between troponin I levels and length of ICU stay after open heart surgery. Methods: A total of 200 patients’ data were collected from January to August 2022 at the cardiac surgery department of National Institute of Cardiovascular Diseases, Karachi. The study was conducted after the approval of Ethical Research Committee. Demographic characteristics of patients, procedure details and post-operative course was taken into account for this study. The troponin I levels were sent 12 hours after the surgery and their effect on ICU stay was studied. Results: The post-operative troponin levels were divided into different sets. There were 61% patients with troponin- I levels less than 9 ng/ml, 28% patients with troponin-I levels between 9 – 18 ng/ml and 11% patients with troponin-I levels of more than 18ng/ml. There was no difference in ICU stay between patients having troponin levels < 18ng/ml. They were all stable and their ICU stay comprised of 24 hours only. Whereas, in the group of patients having troponin levels > 18 ng/ml, the ICU stay was prolonged, extending to 48 - 72 hours. Conclusions: Serum Troponin levels can be used to predict the length of ICU stay. Higher Troponin levels > 18 ng/ml are associated with a prolonged ICU stay of more than 24 hours

Diabetes is a proven risk factor for the development of Acute Kidney Injury after CABG. There are other multiple factors which are involved in causing AKI after CABG like pre-operative renal dysfunction, long CPB time, and low cardiac output syndrome. We controlled all the variables, to study the difference between age and HBA1c levels in predicting acute kidney injury after CABG. Objective: The purpose of the study is to take the diabetic population and control other variables involved in causation of AKI after CABG and study the role of age versus HBA1c levels in predicting AKI after elective CABG. Methods: A total of 200 diabetic patients who underwent elective CABG were selected from May, 2021 May, 2022 at NICVD Karachi. The KDIGO criteria for AKI was applied and diabetics were selected on the standard definition of diabetes. The data for age and HBA1c levels was divided into short sets to increase the accuracy level. Results: The incidence of AKI in our study was 36.5%. There were 52.7% patients who developed AKI with HBA1c of 6.5 – 7.4%; 40% developed AKI with an HBA1c levels of 7.5 – 8.4%, 16% AKI with HBA1c of 8.5 to 8.9%, 12% AKI in patients with HBA1c of 9 – 9.4%, 18% AKI with HBA1c of 9.5 – 9.9%, 20% for HBA1c of 18% and 20% for HBA1c > 10.04%.  There was 4.35% frequency of AKI for age between 40 – 49 years; 26.8% frequency for age between 50 – 59 years; 50.7% AKI for 60 -69 years and 84% for population between 70 to 80 years. Conclusions: Increasing age is a better predictor of AKI following CABG than increasing HBA1c levels till HBA1c level of 10.04%.