Appraisal of myocardial function and early results in both off-pump and conventional coronary artery bypass grafting

Conventional coronary artery bypass grafting [CABG] is both safe and effective. Off-pump coronary artery bypass [OPCAB] is an emerging procedure. It is assumed that elimination of cardiopulmonary bypass for CABG has the potential for reducing postoperative morbidity. The aim of our work is to achieve an evaluation of both CABG techniques as regards indications, surgical techniques, complications, feasibility and indirectly assessing early ventricular function after both procedures. This is a prospective study done in Maadi Armed Forces Hospital. It comprised 66 patients starting on November 2000 till November 2003. Patients were done by 3 visiting surgeons. Patients were divided into 2 groups, group [A] with 33 patients done on CPB from November 2000 till May 2001, group [B] with 33 patients done with off-pump technique using Medtronic Octopus 2-0 and 3-0 tissue stabilizers positioned over the Octobase retractor. Group [A] had an age of mean 49 +/- 6.8 years, while group [B] had an age of mean 52 +/- 7.4 years. No significant statistical difference in age, sex or ejection fraction existed between the two groups [P > 0.05]. Slightly more grafts were performed in the traditional CABG group than in the OPCAB group. There was a highly significant statistical difference [P < 0.001] as regards postoperative cardiac enzymes assay [Troponin I] and operative time in hours, and significant statistical difference [P < 0.05] as regards postoperative ECO improvement. The highly significant reductions in transfusion requirements, intubation time, ICU and overall hospital lengths of stay are very beneficial both to the patient directly and to society in general. All the previous results are in favour of OPCAB procedure with platelets and clotting factors being better preserved, with lower dose of heparin utilized and patients are kept warm throughout the procedure. OPCAB patients are ventilated throughout the entire procedure and many of them are ready for extubation very early, almost immediately at the end of the procedure, with earlier extubation, earlier ambulation and thus quicker recovery and discharge from hospital than the conventional CABG. Hence, our study verifies the impression of a more favourable early clinical result with OPCAB procedure, which has been encouraging with reduced trauma associated with this type of operations. Not all patients can undergo the exciting new OPCAB procedure which differs according to anatomic, hemodynamic considerations together with availability of experience of the surgical team. This new procedure needs careful and objective study in the future

Treadmill test verus Holter monitoring in detection of silent myocardial ischaemia in patients with chronic stable angina

The study was conducted on 34 patients with chronic stable angina [31 males and 3 females] with the age ranging from 29 to 67 years with a mean 49.7 years. Treadmill exercise ECG test showed that 27 patients [79 percent] had a positive result and 7 patients [21 percent] had a negative result. Ten patients [29 percent] had silent ST-segment depression. During Holter monitoring, a total of 48960 minutes were analyzed: 1841 minutes of ischaemic activity were recorded, 1564 minutes [85 percent] were silent. The total number of ischaemic episodes recorded, 147 of which 112 [76 percent] were silent. The total number of patients who developed silent ischaemic on Holter monitoring was 18 patients [54 percent]. Seventeen patients [94 percent] out of those 18 patients had a positive stress test result and one patient [6 percent] had a negative result [P<0.01]. Silent ischaemic episodes are more frequent among patients who developed earlier ST-segment depression on exercise and at lower heart rate and if ischaemica persisted after exercise. The two methods of investigation seem to complement each other in clinical practice to identify subgroup of patients with stable angina at a higher risk of cardiac events