LITA arise from their respective subclavian artery. LITA/LIMA in coronary artery bypass grafting associated with approximately 90% long-term graft patency, improved flow rate and lower mortality and morbidity rate.Spasms can occur during CABG surgery, both during harvesting and after the grafting causes early myocardial ischemia and often reduces early graft flow, which could cause perioperative morbidity and even death in high-risk patients [5]. that may be minimized by the local action of vasodilatory agents i.e.

Objective: To study the incidence of postoperative atrial fibrillation (POAF) and its predictors after coronary artery bypass grafting (CABG) in an Asian cohort. Study Design: Cross sectional study. Place and Duration of Study: The study was conducted at the department of Cardiothoracic Surgery, Almana Hospital, Al Khobar, Saudi Arabia, which is a tertiary care hospital. The study duration was form Oct 2019 to Dec 2021. Methodology: All the male and female consecutive patients with coronary artery disease undergoing coronary artery bypass grafting (CABG) were included in the study. All the surgeries were performed through median sternotomy using cardiopulmonary bypass. Patients with emergency CABG, off pump CABG and those undergoing multiple procedures were excluded from the study. A total of 220 consecutive patients were included in the study. Patients were followed in the perioperative period. Various variables were recorded on a preformed proforma. Patients were divided into two groups, those who had atrial fibrillation (AF) and those who did not have AF. Data was analyzed using SPPS version 23 (SPSS, Inc., Chicago,IL). Results: The mean age of the patients was 51.50±11 years in the AF group and 49.38±9 years in the no AF group. The incidence of atrial fibrillation postoperatively in our cohort was (n=52, 25%). There was no statistically significant difference between the groups with respect to hypertension and diabetes (p=0.408 and p=0.054) respectively). Conclusion: In spite of a younger population, the incidence of AF in our cohort undergoing CABG is comparable to the international literature. Lack of preoperative β-blockers, statins and low ejection fraction are predictors of new onset POAF.

Objective: To compare the early outcome of Coronary Artery Bypass Graft surgery using a combination of antegrade and retrograde cardipoplegia with that utilizing antegrade cardioplegia alone in triple vessel coronary artery disease. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Adult Cardiac Surgery of Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from Sep 2013 to Apr 2019. Methodology: A total of 160 patients with triple vessel coronary artery disease who underwent CABG surgery for 90% or greater stenos is in at least one major vessel in each of the three territories, namely the left anterior descending, the circumflex and the right coronary artery were investigated retrospectively. These were divided into 2 equal groups on the basis of the technique of administration of cardioplegia: in group-1 only ante grade blood cardioplegia was administered for myocardial protection and group-2 was given ante grade and retrograde cardiolplegia. Clinical outcomes like peri-operative mortality and morbidity were recorded, and serum creatine kinase MB, lactate, and mixed venous oxygen saturation levels were monitored. Two dimensional echocardiogram was performed on the 6th post-operative day and follow-up visits were planned 1 week and 4 weeksafter discharge from hospital. Results: There were 2 (2.5%) early deaths in group-1 and no peri-operative mortality in group-2. Five patients in group-1 (6.25%) and 2 (2.5%) in group-2 had non-fatal peri-operative myocardial infarction. However, significant differences included increased incidence of intra-operative ventricular dysrythmias, higher CK-MB levels at 24 hours after surgery, and increased requirement of intra-aortic balloon pump and inotropic support in Group-1. Conclusion: We conclude from this study that the combined delivery of ante grade and retrograde cardioplegia during CABG surgery for triple vessel coronary artery disease provides better myocardial protection and hence better outcome than antegrade cardioplegia alone.Keywords: , , ,

Objective: A weight-based dose of heparin is calculated to achieve target ACT (Activated clotting time) for establishing CPB (cardiopulmonary bypass). Whether a target ACT can be achieved with lower dose of heparin in Pakistani population was the aim of this study. Methodology: The cross-sectional comparative study was conducted at Rawalpindi Institute of Cardiology, Department of Cardiac Surgery from 1st January 2019 to 1st January 2020. Three hundred thirty-six (336) patients undergoing elective open-heart surgeries on CPB were included in this study. Patients receiving weight-based heparin dose were placed in Group-A, while those on low-dose heparin were placed in Group-B. ACT was considered to have reached the target value in range of 400-480 seconds, values between 481-1500 seconds were considered excessive, whereas ACT of >1500 was regarded as potentially high-risk for peri-operative bleeding . Results: 14.1% (n= 28) of Group-A patients achieved target ACT, whereas 58.3% (n=116) exceeded the target of 480. In 25.1% (n=50), ACT values were beyond the measuring capacity of the assay machine i.e. >1500. Only 2.5% (n=5) required additional dosage of heparin. Target ACT in Group B was achieved in 19.7% (n= 27), 55.5% (n=76) had excessive ACT values, whereas in 16.8% (n= 23), it was >1500. 9.5% (n=13) required an additional dosage of Heparin. Conclusion: In Pakistani population, a target ACT can be achieved with significantly lower dose than the conventional weight-based heparin dose. Larger studies, preferably randomized controlled trials are needed to determine the optimal heparin dose calculation for safe anti-coagulation during CPB.

Objective: To study the early outcomes of mitral valve surgery performed with a beating heart and cardiopulmonary bypass. Study Design: Prospective descriptive study. Place and Duration of Study: Cardiac Surgery department, Rawalpindi Institute of Cardiology, Rawalpindi, from Aug 2017 to Aug 2019. Methodology: Consecutive patients requiring mitral valve surgery were included in the study. Those requiring multiple procedures, redo procedures and emergency procedures were excluded from the study. Data was collected on preformed proformas and perioperative variables were recorded. Patients were followed till discharge or 30 days after the surgery. Statistical Package for Social Sciences version 23.0 was used to analyse the data. Results: A total of 27 patients were included in the study, 21 (77.78%) female and 6 (22.2%) male patients. The mean age of the patients was 30.89 ± 10.8 years. Of the cohort, 4 (14.8%) had mitral stenosis, 16 (59.3%) had mitral regurgitation and mixed disease (both mitral stenosis and mitral regurgitation) was present in 7 (25.9%). The median pulmonary artery pressure (mPAP) was 34 mmHg. All the patients received mechanical mitral valve prosthesis, 27 (100%). A modified Devaga’s procedure for tricuspid valve repair was done in 4 (14.8%) patients. Most of the patients required only mild inotropic support, 22 (81.4%). Median intensive care unit stay was 24 hours with a mean of 33 ± 16 hours. All the patients were alive at the end of the early follow up. Conclusion: Beating heart mitral valve surgery on cardiopulmonary bypass is a feasible technique. It has acceptable early outcome in terms of mortality and major morbidity indicators.