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 determine the effect of NAC in prevention of post-operative atrial fibrillation in patients undergoing CABG. Study Design: Quasi experimental study. Place and Duration of Study: Adult Cardiac Intensive Care Unit, Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC&NIHD) Rawalpindi during 6 months. Methodology: 146 patients of both gender undergoing elective CABG were included in the study, having age between 30-70 years. However, any patient with history of arrhythmia including AF, thyroid dysfunction, ejection fraction less than 25%, any valvular lesion, dilated left atrium, dilated left ventricle, dilated right atrium, dilated right ventricle or having right atrial tear during surgery were excluded from the study. By using non-probability consecutive sampling, patients were divided into two groups by using envelope method. One group was given standard treatment (control group) while other group was named as NAC group (experimental group). Data analysis was performed using SPSS version-23. Descriptive statistics were reported as Mean±SD. Categorical variables were reported as frequency and percentage. Chi square test and T-test was used to determine association between different variables. Results: A total of 146 patients with mean age 55.27±7.3 yrs. 127(87%) were male and 19(13%) were females. 28(19.2%) patients had atrial fibrillation while 11(7.5%) patients had ventricular premature contractions (VPC). There was no statistically significant difference between ages (p=0.784), gender (p=0.461), AF (p=0.207) and VPC (p=0.347). Out of 73 (50%) patients from each group; the mean age of NAC group was 55.41±7.3 yrs and of control group was 55.08±7.1 yrs (p=0.784). Gender wise distribution of NAC group had 8(11%) females and 65(89%) males while in control group 11(15%) females and 62(85%) were males. AF was found to be 11(15%) and 17(23.3%) in NAC and control group respectively. In NAC group, VPC was 4 (5.5%) and in control group it was 66 (90.4%). Conclusion: This study shows that NAC decreases the frequency of post-operative atrial fibrillation and ventricular premature contractions, but the decrease is statistically insignificant in Pakistani population. However, keeping in view other beneficial effects of NAC, we would recommend more studies on this subject in Pakistani population.

Objective: Experience of the conventional and a de novo Mitral repair techniques for the treatment of Severe Mitral Regurgitation (MR) in a Tertiary Care Cardiac Hospital of Pakistan. Study Design: Descriptive cross sectional Place and Duration of Study: Cardiac Surgical Division, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, Pakistan Methodology: This was a cross sectional study conducted over a period of 5 years from 2016 to 2020, which included SeventyFive (n=75) patients in the trial, 55 females and 20 males. The mean age was 23±9.5 years (range from 16 to 52 years). Amongst all cases of mitral regurgitation (MR) were five (6%) myxomatous degenerative changes, three (4%) ischemic MR & Sixtyseven (91%) patients had rheumatic aetiology. Five (05) patients with myxomatous diseases required only ring annuloplasty. In patients with ischemic MR, two required chordal shortening for anterior leaflet resuspension, and one required quadrangular resection of the posterior leaflet. Restrictive annuloplasty±Coronary Artery Bypass Grafting (CABG) was alsoperformed as part of the procedures. Sixty-seven (91%) patients having severe Mitral Regurgitation with rheumatic aetiology, required a myriad of procedures; including neo-chordae suspension for anterior & posterior mitral leaflets, quadrangular resection & reattachment of the posterior mitral leaflet. A novel innovative procedure, “Posterior annulus-sliding-plasty” (Nasir’s Technique) was adopted in patients with relatively fixed posterior mitral leaflet. Semi-rigid rings (Carbomedics® or Medtronic CG future®) were used in all the patients to stabilize our repair. Results: There was no operative mortality. Patients were followed up for 01-year. Most of the patients have been found to have adequate intact Mitral Valve Repair. Only 01 patient developed Grade-II MR after 06 months (ischemic aetiology). This patient is being followed up at 06 monthly intervals with transthoracic echo and is being treated as per guideline-directed medical therapy (GMDT) for functional MR. Conclusion: Mitral Valve Repair in the carefully selected subset of patients with severe MR, irrespective of aetiology can effectively be treated with satisfactory short-term and medium-term results.

Objective: To study the relationship of body mass index (BMI) and postoperative bleeding in patients undergoing isolated coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB). Study Design: Analytical cross sectional study Place and Duration of Study: Cardiothoracic services, Almana General Hospital, Al Khobar, Saudi Arabia, from Oct 2019 to Oct 2021. Methodology: Two hundred and twenty (220) consecutive patients who underwent CABG using cardiopulmonary bypass were included in the study. Patients who had additional procedures, those who were operated in emergency and those with significant comorbidities like hepatic and liver dysfunction were excluded from the final analysis. Patients were divided into three groups according to their BMI, healthy weight (BMI 18.5 to <25), overweight (BMI 25 to <30) and obese (BMI >30). The world health organization (WHO) definition was used to define different categories of BMI. Various perioperative variables were recorded for all the patients. Only the immediate postoperative follow up period was included in the study. Data was analyzed using IBM SPSS-statistics 23.0 (IBM, SPSS Inc., Chicago, IL). Results: Of the 220 patients included in the study, 184(83%) were male patients and 36(16%) female patients. There was no significant difference in the mean age of the patients in the three groups (p=0.481). There were significantly more hypertensive patients 46(45%) in the overweight group compared to other two groups (p=0.025). Baseline diabetic status was not significantly different among the three categories (p=0.978). Total mediastinal drainage in the first 24 hours was significantly less in the obese group (3.7±4.45 ml) compared to overweight (4.4±2.7 ml) and healthy weight (7.35±8.5 ml) patients (p=0.001). There was no mortality in the studied cohort. Conclusion: Bleeding after isolated coronary artery bypass grafting is inversely related to BMI. Patients with healthy and overweight BMI are at higher risk of bleeding compared to obese patients.

Objective: To determine the frequency of post-operative pulmonary complications after (coronary artery bypass grafting)CABG surgery and to compare the respiratory complications of post COVID and comparison group Study Design: Analytical Cross- sectional study Study Place and Duration: Study was conducted in Adult Intensive Care Unit, Armed Forces Institute of Cardiology,Rawalpindi Pakistan, from Sep 2021 to Mar 2022. Methodology: 40 patients were selected, and divided into two groups using Non-Probability consecutive sampling. Group-A had history of COVID-19 infection and Group-B was a comparison group and had no history of COVID-19 infection. Patients presenting for elective On-Pump (coronary artery bypass grafting) CABG surgery and known history of COVID-19 were included in our study. Patients of age ranging 30 to 70 years irrespective of gender were included in the study. Any patient who had cardiopulmonary bypass time of more than 120 min, respiratory illness like asthma or Chronic Obstructive Pulmonary Disease (COPD), history of smoking, or requiring post-operative re-ventilation due to cardiac or neurological complication, were excluded from the study. After patients were received from Operation theatre, they were monitored for the respiratory complications and both groups were compared. Results: A total of 40 patients were included in this study having mean age 57.9±7.62 years. Most of the patient population was male 31(77.5%) and only 09(22.5%) were female patients. Study population was equally divided into two groups i.e.20(50%) in comparison group and 20(50%) in post COVID-19 group. There was no significant difference in age (p=0.714), ventilation time (p=0.068), gender (p=1.000), and re-ventilation (p=0.451) of both groups. While Intensive Care Unit stay(p=<0.0001) and non-invasive ventilation (NIV) were found to be significant (p=0.007).