Background and Objectives: Cardioplegia is one of the most significant components used to protect the myocardium during cardiac surgery. There is a paucity of evidence regarding the utilization of whole-blood Del Nido cardioplegia (WB-DNC) on clinical outcomes in coronary artery bypass grafting (CABG). The purpose of this retrospective cross-sectional study is to compare the effectiveness of diluted (blood to crystalloid; 1:4) Del Nido cardioplegia (DNC) with WB-DNC in patients who underwent elective CABG in a tertiary care hospital in Lahore-Pakistan. Materials and Methods: This was a retrospective descriptive study conducted at the Department of Cardiovascular Surgery, King Edward Medical University, Lahore. The medical database of all consecutive patients admitted from January 2018 to March 2020 and who fulfilled the inclusion criteria were reviewed. Results: Out of 471 patients admitted during the study period, 450 underwent various elective cardiac surgeries. Out of 450, 321 patients (71.33%) were operated on for CABG. Only 234/321 (72.89%) CABG patients fulfilled our inclusion criteria; 120 (51.28%) patients received WB-DNC, while 114 (48.71%) patients were administered with DNC. The former group presented with better clinical outcomes compared with the latter in terms of lesser requirements of inotropic support, low degree of hemodilution, shorter in-hospital stay, improved renal function, and cost-effectiveness. Peak values of serum Troponin-T (Trop-T), creatine kinase-myocardial band (CK-MB) release, and activated clotting time (ACT) were also lower in the WB-DNC group compared with the DNC group. Conclusions: The WB-DNC conferred better myocardial protection, improved early clinical outcomes, and also proved to be economical for patients undergoing elective CABG compared with classical crystalloid cardioplegia solution.

Background: Heparin resistance (HR) is a well-known phenomenon inpatients undergoing cardiac surgery. Its effect on outcome has not been studied well. StudyDesign: Prospective observational study. Setting: Department of Cardiac Surgery, PunjabInstitute of Cardiology Lahore. Period: April 2013 to March 2015. Materials and Methods:The study included 300 consecutive patients undergoing on pump coronary artery bypassgrafting (CABG). Those with severe left ventricular dysfunction, multiple cardiac proceduresand emergency CABG were excluded from the study. Data was collected on proformas withperioperative variables. The data was analyzed using Statistical Package for Social Sciencesversion 10. Results: A total of 300 patients were included in the study. This included 60(20%)female patients. The mean age of the patients was 50.76 ±4.67 years. Out of the studied cohort,30(10%) patients showed heparin resistance. Clinical characteristics i.e. hypertension, diabetesmellitus, smoking, hyperlipidaemias and obesity did not show any significance when patientswith and without heparin resistance were compared. Total drain was significantly more in group1 (700±150.13 ml) compared to group 2 (500±120.33 ml) with p=0.023. Similarly, renal failurein group 1 vs group 2 (30.0% vs 15.4%. p=.017), use of blood products more than two units ingroup 1 vs group 2 (83.30% vs 10.7%, p= .003), re-exploration for bleeding in group 1 vs group2 (30.0% vs 5.5%, p=.003) was significantly more in group 1 vs group 2 respectively. Mortalitywas insignificant in both groups. Conclusion: Heparin resistance occurred in 10% of thepatients. Patients with heparin resistance lead to poor postoperative outcomes like increasedrenal failure, bleeding, rate of re-exploration and increased use of blood products but does notlead to increased mortality in patient with comparatively lower risk profile.

Aim: To compare conventional ultrafiltration (CUF) with zero-balanced ultrafiltration (Z-BUF) in the patients having valvular heart surgery. Methods: This cross-sectional mono-centered retrospective study was designed. The data of total 471 patients were reviewed during March 2018 to February 2020, only 98 patients fitted in the inclusion criteria and were divided into two groups with 47(47.95%) patients received CUF, while 51 (52.04%) patients were administered with Z-BUF at the Department of Cardiovascular Surgery, King Edward Medical University, Lahore, Pakistan. Statistical analysis was done using SPSS version 25. The early postoperative clinical outcomes included, renal function as primary outcome and hemodynamics stability of the patients as secondary outcome. Results: Renal functions in terms of serum creatinine (1.1 vs. 1.3mg/dL; P < 0.010) and creatinine clearance ratio (81.51vs. 67.3mL/min; P < 0.01) were improved in the patients having Z-BUF compared with CUF. Urine output was almost double in the Z-BUF cohort compared with the CUF. The hemofiltration technique had no impact on the secondary outcomes as amount of the blood loss and number of patients required blood transfusion were similar (P > 0.05) in our cohort. Conclusion: Z-BUF appeared to be better hemofiltration method than CUF during CPB when assessed in terms of renal protection without hemodynamic status in patients undergoing valvular heart surgeries in our population. Keywords: Cardiopulmonary bypass, Ultrafiltration, Renal injury, Hemoglobin, Blood transfusion

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