Background: Atrial Fibrillation (AF) is common in early recovery period after cardio-thoracic surgery. There have been several pharmacological and nonpharmacological strategies suggested for prevention against AF after coronary artery bypass grafting. The purpose of this study was to evaluate the effect of oral amiodarone in the prevention of atrial fibrillation in patients who underwent off pump coronary artery bypass graft (OPCAB).Methods: This interventional study was conducted from February 2017 to January 2018 in the department of cardiac surgery, National Institute of Cardiovascular Disease (NICVD) Dhaka, Bangladesh. By purposive sampling a total of 100 patients having sinus rhythm who will undergo OPCAB were selected for the study. Among them 50 patients (Group-A) got amiodarone (600mg/day started 3 days prior to surgery) and 50 patients (Group-B) did not get amiodarone. Two (2) patients of group-A were excluded from the study due to conversion to on pump from off pump during operation. So, finally group A had 48 patients and group- B had 50 patients. Preoperative electrocardiography (ECG), serum electrolytes (e.g. potassium & magnesium), thyroid function test, liver function test and echocardiogram were done in all patients under study. Per-operative occurrence of AF was assessed on operation theatre monitor. Each patient was evaluated by continuous ECG up to 5th post-operative day (POD). Serum potassium & magnesium were measured in every alternative day up to 5th POD. ECG with long lead tracing was done for all patients on the day of hospital discharge & was recorded. Data were analyzed by SPSS 24.0 (Statistical Package for the Social Sciences) and tested by student T-test and Chi-square test. P < 0.05 was considered significant.Results: Pre-operative baseline characteristics were similar in both groups. Per-operative and postoperative AF occurred more frequently in group B than group A. Those were 10(20.83%) and 32(64.0%) peroperative, 9(18.75%) and 31(36.0%) immediate postoperative period respectively in group A and group B. The result was statistically significant (P value<.05). Post-operative amiodarone used in all patients who developed AF irrespective of groups. This also decreased AF significantly. There were statistically no significant difference found in postoperative serum electrolytes and use of inotropes, anti-arrhythmic drugs. All patients recovered well.Conclusion: This study concluded that preoperative oral administration of amiodarone can prevent the occurrence of atrial fibrillation in patients undergone Off Pump Coronary Artery Bypass (OPCAB).Bangladesh Heart Journal 2018; 33(1) : 67-73

Introduction:The long-term patency of conduits used is one of the most important variables in determining long-term outcomes aftercoronaryarterybypass grafting (CABG) 1 .It has been well documented and demonstrated that the use of the left internal mammary artery (LIMA) to graft the left anterior descending (LAD) artery is gold standard for conventional CABG operations and has signiûcant beneûts compared with using asaphenous vein graft (SVG) 1 .Its use has been shown to result in a lower incidence of re-intervention, fewer myocardial infarctions, a lower incidence of angina, and lower associated mortality rates than with the use of saphenous vein grafts alone 1 .It was assumed that this inherent superiority of the LIMA over SVG would also be true of other arterial conduits such as the right internal mammary artery (RIMA), the radial artery (RA) and the right gastroepiploic artery (RGEA). 1 This assumed inherent superiority of using any arterial conduit compared with using an SVG to targets other than the LAD artery has been much harder to prove. Conduit selection for the left circumflex and right coronary artery territories has been more variable amongst surgeons. 2 right ITA is less useful than the left ITA, as it will not always reach the right coronary artery (RCA) branches without tension, leading to its use predominantly as a free graft, with a lower patency rate when attached to the ascending aorta. Another reason for cautious use of bilateral ITA was related to the increased risk of sternal wound infection. Results: This study reports on our series of 200 patients undergoing isolated, primary CABG using LIMA grafting and the SVG in one group, and RA grafting as the second conduit in the second group. Our data indicate that there is no difference in the long-term clinical outcome between the patients in whom RA or SVG is used as a second conduit, beside LIMA. Conclusion:In this small randomized study our data indicate that there is no difference in the 4 year clinical outcomes in relatively young patients between those having a RA or a saphenous vein graft used as a second conduit, beside LIMA, for surgical myocardial revascularization.

Background: Diabetes mellitus is an independent risk factor for coronary artery disease and it adversely affects the postoperative outcome after CABG surgery. Adequate control of diabetes for a longer period, which can be assessed by HbA1c, before OPCAB may reduce development of postoperative atrial fibrillation and thus improve outcome. Methods: This was an observational study included sixty diabetic patients purposively who underwent isolated off pump coronary artery bypass procedure in NICVD. Total sample contained 60 diabetic patients, which were divided in two equal groups. Grouping was Group I – 30 Diabetic patients with preoperative HbA1c <7% and Group II – 30 Diabetic patients with preoperative HbA1c ≥7% and all of whom underwent isolated OPCAB. Postoperative atrial fibrillation and other complications were recorded and compared in two groups of patients. Results: Most postoperative atrial fibrillation (AF) developed in higher age group 61-70 years (61.5%). Postoperative complications were higher in group II. Postoperative AF was significantly higher in diabetic patients having preoperative HbA1c ≥7% compare to diabetic patients with HbA1c <7% in early postoperative period after OPCAB. Age (61-70 years) (OR=1.872, p=0.018), preoperative HbA1c ≥7% (OR=19.029, p=0.002) and hypertension (OR=1.091, p=0.019) was found significantly associated with increased development of postoperative atrial fibrillation. Conclusion: Our study revealed that higher preoperative HbA1c level was associated with increased incidence of new onset atrial fibrillation after OPCAB. So, it can be used as a reliable indicator for adequate control of diabetes preoperatively among patients selected for isolated elective OPCAB in future. Cardiovasc. j. 2020; 12(2): 113-119

Background: Cardiopulmonary bypass (CPB) is an unphysiological state and widely regarded as an important contributor to renal failure. Despite improvement in cardiopulmonary bypass technique, anesthesia and intensive care, perioperative renal dysfunction still represents a significant and potentially lethal complication after coronary artery bypass graft surgery (CABG). Renal dysfunction is a serious complication of coronary revascularization with CPB and results in increased morbidity, mortality and prolonged hospital stay. We compared the incidence of perioperative renal dysfunction in patients who underwent CABG, on-pump and off-pump (OPCAB) Methods: A total of 60 high -risk patients with ischaemic heart diseases were included in the study who underwent CABG. Out of the total 60 patients, 30 were in the Off-pump group (Group A) and the rest 30 were in the On-pump group (Group B). They were diagnosed as high-risk patients considering serum creatinine level>1.7mg/dl with age ?60 years, ejection fraction 30-40%. Renal function was evaluated in both groups preoperatively and postoperatively (on 1st, 2nd and 7th postoperative day) and compared between two groups.Results: One patient in the On-pump group died on 6th postoperative day. Preoperative renal parameters were also similar and showed no statistically significant difference. So both groups were comparable. Comparison of renal parameter in OPCAB and on-pump CABG between preoperative and 7th day postoperatively found in this study were blood urea 50.33±6.29, 39.87±4.8 vs 52.67±9.05 , 66.21±6.91 ; S. Creatinine (mg/dl) 1.94±0.19 , 1.28±0.19 vs 2.07±0.31 , 2.82±0.47; Creatinine Clearance Rate(ml/min) 46.61±4.1, 71.51±12.3 vs 46.53±4.6, 34.02±4.49 ; Urine output (ml/24 hrs)1692.7±71.53, 1755.7±82.91 vs 1591.2±78.76, 1492.1±196.29 all are statistically significant(p<0.05). Mean period of mechanical ventilation, ICU stay and total postoperative hospital stay were significantly greater in On-pump group. One patient of Group –B died due to multi organ failure including acute renal failure on 6th postoperative day (3.3%) (p>0.05). Statistically significant difference of renal parameters in different postoperative days showed evidence of well preservation of renal function in OPCAB.Conclusion: Adaptation of OPCAB offers better preservation of renal function as well as better early postoperative outcome specially in high-risk CABG patients.Cardiovasc. j. 2016; 9(1): 23-30

Introduction: Left ventricular dysfunction is an important predictor of in-hospital mortality. Due to the theoretical and practical advantages to avoid the harmful effects of cardiopulmonary bypass (CPB), many cardiac surgeons are using Off-pump Coronary Artery Bypass (OPCAB)as an effective alternative to conventional CABG (CCAB) even in patients with reduced left ventricular (LV)ejection fraction. Objectives: This study performed in the National Institute of Cardiovascular Diseases (NICVD) evaluated the early outcomes of OPCAB in terms of mortality and major post-operative morbidities and compared them with that of CCAB in patients with multivessel coronary artery diseases and reduced left ventricular (LV) function. Methods: Total 120 patients with multivessel coronary artery disease with reduced left ventricular ejection fraction (d”50%)were allocated into two groups: a) 60 patients who underwent OPCAB and b) another 60 patients who underwent conventional CABG between January 2013 and December 2015. Pre-operative, peroperative and early post-operative variables were recorded, compiled and compared. Results: All risk factors and co-morbidities were homogenously distributed between the two groups. Majority of the patients had triple vessel disease. Nearly three-quarter (73.3%) of patients in OPCAB group and 80% in CCAB group received 3 grafts (p=0.470). The mean total operative time (268.5 ± 33.5vs. 296.3 ± 34.8minutes, p < 0.001), intubation times(8.6±0.3 vs. 12.3±0.5 hours, p<0.001), blood losses (377.8378 ± 45 ml vs. 602 ± 60 ml, p < 0.001); requirements for blood and blood products (689.7±21.1 vs. 1199.3±34.5ml, p < 0.0010),intensive care unit stays (31.7±0.9 hours versus 41.6±1.5 hours; p<0.001) and hospital stays (8.2 ± 0.2days vs.10.3 ± 0.3days, p < 0.001)were all significantly lower in the OPCAB group. Conclusion: OPCAB is a safe and effective operative revascularization procedure for patients with multivessel coronary artery disease and left ventricular dysfunction and is associated with reduced morbidity. However, a larger and omized trial with long-term followup may show the real benefits of OPCAB. Bangladesh Heart Journal 2020; 35(1) : 20-27