Introduction: Serum albumin has a close correlation with degree of malnutrition which is associated with poor outcome and quality of life after cardiac surgery. Hypoalbuminemia is associated with increased wound infection, prolonged hospital stay and death after major surgery. Although there are many risk assessment methods available which are used to assess risk of cardiac operative mortality and morbidity but they have some limitations. Hence, preoperative serum albumin level can be utilized to upgrade risk models which will further benefit the cardiac surgical patients without extra financial burden. Objective: To evaluate the role of serum albumin as a predictor of morbidity and mortality after valve replacement surgery. Materials and Methods: This comparative cross-sectional study was carried out at the department of cardiac surgery in BSMMU. The study population was 50, with two groups having 25 patients each. Grouping of patients were done with respect to a preset cut off value for serum albumin. The period of study was from August, 2018 to February, 2020 and purposive sampling method was applied for this study. Data was collected by using a standardized semi-structured questionnaire and face to face interview. Results: In comparison to demographic characteristics, mean age in group A and B were 41.6011.16 years & 49.96±8.69 years respectively, which was found statistically significant (p=0.005). Gender distribution was insignificant but BMI was found statistically significant in between groups (p<0.05). Difference in terms of preoperative risk factors and investigations, no statistical significance found in between groups. Comparison of peroperative variables were also found statistically insignificant. In terms of postoperative outcome, total chest drain collection was higher in group B (968.80±183.49 ml) than group A (816.00±113.40 ml), which was statistically significant (p=0.001). Similarly, duration of ICU stay and hospital stay were longer in group B (4.60±0.76 days & 9.88±1.56 days respectively) than group A (3.92±0.86 days & 8.64±0.81 days respectively), which were found statistically significant (p=0.005 & p=0.001 respectively). Among postoperative complications wound infection was found much more in group B (16%) compared to group A (4%), but that was not found to be statistically significant (p>0.05). In comparison to overall morbidity and mortality, higher morbidity was seen in group B (48%) compared to group A (20%), which was found statistically significant (p<0.05), but difference in terms of mortality was not found statistically significant, though it was higher in group B (12% compared to 4%). Pearson co-efficient correlation test showed strong inverse relationship of serum albumin with total chest drain, ICU stay and hospital stay following valve replacement surgery (r= -0.473, r= -0.448 & r= -0.487 respectively), which was most significant than age and BMI (p≤0.001). Multivariate logistic regression analysis was done to assess the predictive value of serum albumin level, age and BMI, where preoperative serum albumin level was found to be the most valuable predictor of postoperative morbidity after valve replacement surgery (B= -2.251, OR 0.105, 95% CI 0.011-0.986, p<0.05). Conclusion: This study demonstrated that preoperative low serum albumin level is associated with increased morbidity and mortality after valve replacement surgery. Hence preoperative serum albumin level can be used as a reliable predictor of postoperative outcome. Key words: Morbidity, In-hospital mortality, preoperative serum albumin level, valve replacement surgery.

Background Red cell distribution width (RDW) level is routinely provided in a simple and inexpensive complete blood count report. However, RDW is sometimes overlooked. Recently a higher RDW level is found associated with postoperative mortality after off-pump coronary artery bypass. Many risk-prediction tools are available, like the European System for Cardiac Operative Risk Evaluation, Society of Thoracic Surgeons score, etc. but all need improvement for better prediction. So, a new risk-factor should be discovered which is simple enough for clinical use and cost-effective, and improves the risk assessment tools that help to predict and avoid preventable mortality following cardiac surgery. Methods The prospective study was conducted, taking a total of 150 patients of coronary artery disease who underwent elective isolated off-pump coronary artery bypass. The study population was grouped according to their preoperative RDW level as Group A (RDW ≤ 14%), Group B (RDW 14–16%), and Group C (RDW ≥ 16%). The receiver operating characteristic (ROC) curve was constructed and multivariate regression analysis was done to see the predictive value of RDW for in-hospital mortality. Results The mortality rate was 2.7%, N = 150. ROC curve revealed Area Under the Curve 0.841 and p = 0.020 that indicates the RDW as the reliable predictor for in-hospital mortality. Multivariate regression analysis showed the RDW to be the only variable independently predicting in-hospital mortality after off-pump coronary artery bypass among possible haematological predictors. (OR 1.838, 95% CI 1.061–3.186, p = 0.030). Conclusion Preoperative raised RDW level is a novel predictor of in-hospital mortality after off-pump coronary artery bypass. Further studies should be done to determine the associated mechanism.

Original Research Article Introduction: Post-operative blood loss remains a major problem after cardiopulmonary bypass. The increased bleeding tendency after cardiac surgery using cardiopulmonary bypass is a complex result of multiple hemostatic defect including coagulation factor deficiency, inadequate neutralization of heparin, increased fibrinolytic activity & platelet deficiency in quantity & quality. In this study effect of Fresh Frozen plasma on post-operative blood loss was evaluated. Objective: To evaluate the relation between post-operative blood loss and transfusion of fresh frozen plasma of the patient undergoing cardiac surgery with cardiopulmonary bypass. Materials and Methods: This comparative cross sectional study was carried out at the department of cardiac surgery in BSMMU hospital. The study population was 60, with each group having 30 patients. Grouping of patients were done with respect to transfusion of fresh frozen plasma (group a patients who were received FFP and whole blood & group B: patients who were received whole blood only). Demographic, pre-operative and post-operative data were analyzed statistically to establish the hypothesis. There was significant difference in age, cross clamp time, total bypass time between two groups. Results: Total sixty (60) patients who underwent cardiac surgery with cardiopulmonary bypass were included in this study as per the inclusion and exclusion criteria. Patients were grouped into group A and B on the basis of per-operative & post-operative transfusion. Patient in group A received FFP & blood whereas patients in group B received whole blood only. Surgical procedure and ICU care were adopted on standard hospital protocol. Among the study population mean age in group A was 27.43±7.53 years and in group B was 32.37±7.54 years. The difference in age between two groups was statistically significant (p<0.05). There was no statistical significance of gender between the two study groups (p>0.05). The mean BMI in group A was 24.13±2.49 kg/m² and that in group B was 24.62±3.71 kg/m². The findings were not statistically significant (p>0.05). Blood loss was significantly greater in group B compared with group A within 48 hours of operation and also patients in group B had longer ventilation time, ICU stay and hospital stay. Regarding Pearson's co relation test, cross clamp time was positively and amount of FFP transfusion was negatively co relate with post-operative blood loss. Variables that have significant relationship with post-operative blood loss were not showed significance in multivariate binary regression analysis, so only transfusion of fresh frozen plasma mostly related to post-operative blood loss following cardiac surgery with cardiopulmonary bypass. Conclusion: From this study it reveals that per-operative and post-operative transfusion of Fresh Frozen plasma can effectively reduce post-operative blood loss especially in on-pump cardiac surgery as well it reduces post-operative morbidity, hospital stay.

Background: Vigilance ensures safety in cardiac surgery. Performance in cardiac surgery is often measured by short-term mortality. Several risk factors like advanced age, female gender, higher body mass index, decreased left ventricular function, emergent, and redo operations have appeared recurrently as poor prognostic variables. Evaluation of postoperative mortality is crucial to find loopholes to provide proper care and reduce preventable mortality after cardiac surgery in developing countries with limited infrastructures and resources. Methods: This is a retrospective study conducted in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University. Perioperative data of 100 cases of mortality after cardiac surgery performed from 1 January 2014 to 30 May 2018 were collected from the university medical record. The data on age, gender, body mass index, preoperative investigations, diagnoses, types of operations, details of cardiopulmonary bypass, and postoperative period of the study populations were evaluated. Results: During the study period, about 1627 cases of cardiac surgery were done with an overall mortality rate of 6.15%. The mean age was 41.05 ± 20.19 (0-68) years, and 66% of patients were male. Preoperative ejection fraction (EF) of the study population was an average 56.63% ± 11.85%; 9% of the patients had EF < 40%. Off-pump coronary artery bypass (32.27%) was the most commonly performed surgery followed by mitral valve replacement (24.28%). On-pump cardiac surgery was done among 65% of the study population with a mean cross-clamp time and bypass time of 32.56 ± 11.55 minutes and 80.57 ± 18.09 minutes, respectively. Most of the mortality was found in the first two weeks after surgery. Conclusion: Mortality after cardiac surgery is multifactorial. A large-scale prospective study with comparative groups is required to find out preventable measures of mortality after cardiac surgery which will improve the quality of services provided to the patients in developing countries.

Abstract:Background: Since the development of atherosclerosis involves dyslipidemia, we postulated that green tea may exert