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Background: Off-pump Coronary Artery Bypass (OPCAB) has become the standard surgical treatment of Coronary Artery Disease in most centres in India. It is clear from the current evidence that, in certain patients, OPCAB olTers advantages over conventional Coronary Artery Bypass Grafting (CABG). Experience of this procedure in the Armed Forces is highligbted. Methods: Retrospective analysis of 200 nonrandomized consecutive patients taken up for OPCAB and 200 conventional CABG between Jan 2005 and Dec 2007 was done. The European system for cardiac operative risk evaluation (euroSCORE) was used in all patients. Perioperative morbidity and mortality was compared in the two groups. Result: OPCAB was possible in 192 (96 %) out of200 patients taken up for this procedure. Eigbt patients required cardiopulmonary bypass (CPB) to complete the revascularization. Incidence ofreoperation for bleeding was 2.5% in OPCAB and 6% in CABG In the CABG group 2 % patients developed severe bleeding complications, 3 % required ventilation for more than 24 hour, 1 % required renal replacement therapy, 1 % had acute respiratory distress syndrome and 3.5 % had neuro-psychiatric manifestations. Incidence of these complications in OPCAB patients was lower or NIL. Overall mortality in the OPCAB group was 1.5 % and 2 % in the CABG group. However only one patient out of 192 (0.5 %) who underwent successful OPCAB died, while two patients out of eigbt who required conversion to CPB in this group died. Incidence of stroke, deep sternal infection and mortality was similar in both groups. Conclusion: OPCAB is safe, effective and can be offered to more than 90 % patients as the primary strategy for surgical myocardial revascularization. It has lower overall morbidity than conventional CABG Its main limitations are hemodynamic instability and inability to lind a deeply embedded target vessel. Both these factors offect the outcome adversely making conventional CABG a better option in these situations. MJAFI 2010; 66 : 357-361

Introduction: Double patch technique pioneered & published by Novick WM, Sandoval N et. al. for the repair of VSD with severe pulmonary hypertension. (The Annals Of Thoracic Surgery Vo1. 77, No. 1, Jan 2005) indicated good results in the hig risk VSD -closure.Methods: A total of 185 cases of isolated VSD were operated at our hospital since January 1998 -till date. Age ranged between 1 month to 33 years (mean 8.2 years). Sex ratio 1:2 (M:F). Out of 185 cases, 37 cases had normal PA-pressures, 74 had moderate PAH between 40 -60 mmHg and the rest had severe PAH (> 60 mmHg). 5 cases had pulmonary artery pressures (PAP), which were equivalent or little above systemic pressure. In the normal course we would have recommended medical treatment. But we were encouraged to use the double-patch technique, pioneered by Novick WM, Sandoval N et. al. All the 5 cases were females age range between 4 years to 8 years (mean 7 years). VSD was closed on CPB using moderate hypothermia with double patch technique (Sauvage-dacaron patch) through RA. Maneuvers to manipulate the pulmonary artery pressure were undertaken pre-, intra-& post-operatively. Though they had prolonged ventilation and ICU-stay, all of them recovered. PAH continued, though the PAP came down marginally, yet we found that in due course the PAP further fell to mild to moderate level over period of 3 to 4 months.Conclusions: This is a good technique for un-operable VSD with severe pulmonary hypertension and give gratifying results.