Background: Defending the heart against potential damage during cross-clamping is the most important and vital step to ensuring a successful surgical outcome(1). The creation of cardioplegia solutions was one of the major advances in cardiac surgery that allowed surgeons to conduct complicated surgical procedures to avoid myocardial injury (14). Treating cardioplegia at a cool temperature would be a significant factor in lowering myocardial metabolism. However, the reduction in myocardial metabolism due to hypothermia, compared with that achieved by diastolic arrest, is usually very negligible. Since Normothermias enzymatic and cellular processes work better (7). Owing to the propensity of the heart to resume electrical operation during normothermia, however, this must be administered consistently or only with short interruptions (4). Terminal warm blood cardioplegia (hot shot) is normally done just before the elimination of the aortic cross-clamp since it has been demonstrated that myocardial metabolism is increasing (23). Methods: A prospective controlled randomised study (200 hundred patients aged 40 to 65 years of both sexes underwent elective CABG pump surgery) will be included. They will be divided into three groups of patients: Group I:includes 100 Patients who received intermittent cold blood cardioplegia. Group II:includes 100 Patients who received intermittent warm blood cardioplegia with controlled reperfusion for 3 minutes before aortic unclamping. Study made from January, 2019 to August, 2020, at National Heart Institute.All patients were thoroughly evaluated preoperatively, intraoperatively, and postoperatively. Results: We hypothesized that in our patient cohort, warm blood cardioplegia could be as successful as or even better than the conventional antegrade cold blood cardioplegia. Patients were randomised into two similar blocks, each of which consisted of 100 patients, each of whom obtained one of the two cardioplegic solutions. Our analysis did not indicate a statistically important difference in the post-operative release of myocardial biomarkers (Troponin I) & CK in both classes. This finding did not significantly reflect the clinical outcome of our patient, which may indicate similar myocardial protection in primary low-risk CABG patients for both cold and warm blood cardioplegia. Conclusion: During the time of cardiac arrest, both methods tend to enable an equal and adequate approach for myocardial defence. To attain improved myocardial defence, warm blood cardioplegia needs a shorter administration interval. Therefore, the choice between one type of cardioplegia and the other remains at the discretion of the surgeon. The statistically minor variation found in the release of myocardial enzymes did not translate into distinct clinical results.

Background:Long-term morbidity and mortality appear to be associated with mitral valve replacement for mitral valve disease. The morbidity rate has not decreased dramatically over the years, despite enhancements in myocardial safety and prosthetic valves. Cardiac failure is the most common cause of death following MVR. Subvalvular apparatus preservation preserves LV function and thus improves survival. Repair, particularly with rheumatic valve disease in young patients and extremely disorganised valves, is not always feasible or effective. The use of smaller valve prothesis was not only the argument of preserving the anterior leaflet, but also that it could cause LVOT obstruction. Methods:A prospective controlled randomized study will include(sixty patients aged from 25 to 55 years of both sexes) They will be divided into two groups of patients: Group I: thirty patients who underwent MVR without preservation of The chordae tendinae of the anterior mitral leaflet and only preserving the posterior mitral leaflet. Group II: thirty patients who underwent MVR with complete or partial Preservation of the chordae tendinaeof the anterior mitral leaflet. Results:The sixty patients were divided into two groups where 30 of them underwent preservation of AML, These patients had a better LV function in the early and the short term postoperative period. Conclusion:Results of this study concluded that preservation of the AML leads to better postoperative outcome. We recommend its application on a greater scale of cases of MVR.

Atrial fibrillation (AF) is the most common sustained arrhythmia that is associated with significant morbidity and mortality. Current available treatments remain ineffective for symptom management and secondary prevention and are often associated with serious side effects. While electrophysiological remodelling has been identified as a significant initiating stage, the mechanisms underlying AF pathogenesis are poorly understood. Growing research recently has implicated oxidative stress and inflammation in AF pathogenesis. In order to support the use of antioxidant vitamins C and anti-inflammatory statin combined with Bblocker in the prevention of AF post CABG, we searched the literature for proof. Antioxidant vitamin C has shown a role in AF prevention post CABG through its reactive-oxygen-species-(ROS-) scavenging impact. Methodology: A prospective controlled randomized study will include (three hundred patients aged from 40 to 65 years of both sexes). They will be divided into three groups of patients: Group I: A hundred (CABG) patients commenced on only B-blocker for at least one week pre-operatively. Group II: A hundred (CABG) patients commenced on B-blocker & ascorbic acid for at least one week pre-operatively. Group III: A hundred (CABG) patients commenced on B-blocker& statin for at least one week pre-operatively. Results: 24 patients out of 100 patients in the 1st group experienced atrial fibrillation, compared with 6 out of 100 in the 2nd group, and 7 out of 100 patients in the 3rd group experienced atrial fibrillation. Conclution: combination of B-blocker with ascorbic acid & statin is better than B-blocker alone in reduction of atrial fibrillation after CABG in early post operative period.