Coronary artery bypass grafting on beating heart. does it provide superior myocardial preservation than conventional technique?

To compare myocardial injury caused by 3 commonly used methods for coronary artery bypass grafting [CABG]. A prospective randomized study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. The study started in February 2003 and concluded in April 2004 after including 45 patients [15 patients in each of 3 sub-groups] who fulfilled the inclusion and exclusion criteria. The subgroups included coronary artery bypass surgery performed by: a] conventional technique, b] off-pump technique, and c] on-pump beating-heart techniques. All patients had similar operative risk profiles. Their ages were 70 years or less with an ejection fraction of 30-50%. The creatine kinase, myocardial band [CKMB] levels were determined 2 hours after arrival from the operating room then, at 4 hours, 6 hours, and 12 hours. The comparison of creatine phosphokinase and CKMB levels was carried out using analysis of variance with repeated measures. The p-values were used to evaluate the significance of differences. The pre-operative characteristics including age, gender, ethnic origin, diabetes mellitus, hypertension, and left ventricular function, were similar in the 3 groups. All groups had a median number of 3 bypass grafts. The stay in the intensive care unit and the duration of inotropes were shortest in the off-pump group, but the difference was not significant. There was a peak of CKMB levels at 6 hours in all groups. The trend of CKMB level showed significantly higher values in the conventional CABG group as compared with the other 2 groups. This study indicates that the off-pump technique provides better myocardial preservation than other methods

Prophylactic antibiotic in cardiac surgery - does duration of prophylaxis effect the outcome?

To evaluate that duration of prophylactic antibiotics in patients undergoing open-heart surgery have an impact on deep sternal infection. [Mediastinitis]. Cross sectional comparative study on patient undergoing open-heart surgery. This study was conducted at cardiac surgery department, Mayo Hospital Lahore. It included patients operated from May 2005 to July 2006. Duration of study was 14 months. Total of 200 patients undergoing open-heart surgery were included in the study. We compared 100 patients, receiving less than 48 hours of prophylactic antibiotics [Group A] with another 100 patients, receiving more than 48 hours of prophylactic antibiotics [Group B]. The endpoint of study was development of mediastinitis requiring sternal rewiring. Ten patients were rewired for sternal dehiscence [5%]. Test of proportion was applied and it was concluded that there is no difference in proportion of infection in the two groups. [p value of 0.05]. Conclusions: The results provide evidence that there is no need to continue antibiotic prophylaxis for more than 48 hours in patients undergoing open-heart surgery