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Objectives: The aim of this study was to determine the frequency of operative mortality in patients who had low serum albumin on admission and were undergoing coronary artery bypass grafting (CABG) after nutritional support at a tertiary care cardiac center in Karachi, Pakistan. Methodology: A retrospective study was conducted at an adult cardiac surgery department of the largest tertiary care cardiac center in Karachi, Pakistan. Patients who had undergone isolated CABG during January to December 2019 admitted with low serum albumin (less than 3.5mg/dl) and received nutritional treatment before surgery were included in the study. Patients were monitored for a month to measure the 30 day mortality. Results: There were 82.4% male patients and the mean age was 55.49±8.52 years. Preoperative mean serum haemoglobin, serum creatinine, and serum albumin levels were 12.225±1.19 mg/dl, 1.05±0.21 mg/dl, and 2.825±0.39 mg/dl respectively. Postoperative mortality was recorded in 1.7% of the total patients. Conclusion: In patients with low serum albumin levels and had undergone isolated CABG after nutritional pre-treatment, mortality was mainly associated with peri-operative myocardial infarction. While, the incidence of delayed wound healing and atrial fibrillation were found to be high in these patients.

Angioplasty balloon entrapment remains an infrequent but dangerous obstacle that requires forbearance and pre-built management strategies in order to avoid morbidity or worse, mortality. Here, we discuss an un-expected hurdle of an undeflated stuck balloon with fractured shaft during angioplasty of proximal right coronary artery (RCA) in a 60-year-old male which was attempted percutaneously and redeemed surgically but massive infarction to RCA territory was inevitable.

Tetralogy of Fallot (TOF) is commonly identified cyanotic congenital cardiac anomaly; however, its affiliation with dextrocardia and situs inversus is very rare. We describe a case of dextrocardia and situs inversus associated with TOF in a 23-year old girl who arrived with central shunt at the age of 17 years and later for total surgical correction with magnificent outcomes.

Objective: To evaluate the outcomes and cost-effectiveness of cardiac surgery performed in a newly developed center providing affordable surgical care. Methods: This descriptive study was conducted at the Medicare Hospital Karachi, from January 2016 to October 2017. Patients undergoing open-heart surgery with cardiopulmonary bypass were enrolled, and those presenting with cardiogenic shock and off-pump cardiac surgeries were excluded. Data were prospectively collected on the designed questionnaire. Results: A 127 consecutive patients, predominantly male, 72%, with an overall median age of 58±15 years were identified. Ninety percent had CABG, 5.5% had MVR, 1.6% had AVR, 0.8% had CABG+MVR, and 1.6% had CABG+AVR. A majority, 50.4%, had 1+2+3 grafts. Sixty percent had a CPB time between 60-90 minutes and ventilation of less than six hours in 88% patients. Peri-operatively 97% of patients received transfusion, 2.4% developed renal dysfunction, 1.6% sepsis, 3.2% arrhythmia, and 71% received inotropes. In-hospital mortality was 1.8%, ICU stay >5 days and hospital stay >8 days was found each in 1.6% of patients respectively. Conclusion: We demonstrated impressive results compared with strong Western standards. Further comparative studies with greater sample size are required to assess the outcomes, survival, and cost-effectiveness in this region. Key words: Coronary artery bypass grafting (CABG), Outcomes, Cost-effectiveness