Arterioplasty in diffuse coronary artery disease is a safe alternative

To assess the efficacy of coronary arterioplasty in patients who have more aggressive and diffuse coronary artery disease. This is a retrospective observational study of cases performed over nine year period [Jan 2000-Dec 2008]. Thirty five patients, with diffuse coronary disease had arterioplasty. Their perioperative course was compared with a similar number of patients with matching profile but relatively better coronaries. Fourty arterioplasties were performed in 35 patients. There were 30 males and 5 females. Mean age was 53.46. Clamp time and ventilation time in ICU was longer in this group compared with control group. Need for ionotropic support and ICU stay were same in both groups. There was no other morbidity or any mortality in either group. Follow-up for six months was complete. Patients remained active and symptom free. Coronary arterioplasty is a safe and effective alternative, in a group of patients who have diffuse coronary disease

Conversions in off-pump coronary artery bypass grafting: analysis and outcome

Off-pump coronary artery bypass graft [CABG] surgery is supposed to reduce perioperative mortality and morbidity compared with on-pump coronary bypass graft surgery. The causes of hemodynamic collapse during off-pump coronary artery bypass [OPCAB] remain scarcely defined. We present an analysis of 7 cases who were converted to conventional CABG due to sustained hemodynamic collapse or else, during elective off-pump CABG. During a 12-month period, we performed 77 elective OPCAB procedures through a sternotomy, constituting 56.2% of the total CABG procedures performed. Six patients [1.6%] experienced hemodynamic collapse intra-operatively and one [0.23%] electively requiring immediate cardiopulmonary bypass. Preoperative characteristics, intraoperative data, and postoperative outcome were retrospectively reviewed. In all cases, improvements in intra-operative technique and/or judgment could be made retrospectively. Six of these patients were converted in emergency, and on electively to cardiopulmonary bypass. Three [3/77] patients had an unstable course and did not survive operation. The causes of hemodynamic collapse during elective OPCAB were ischemic, mechanical, or a combination of both. Based on these results, strong consideration should be given for a planned strategy of CPB in high risk patients

Off-pump coronary artery revascularization trend in Karachi: a local survey

A survey of local cardiac surgeons was carried out to know their views about off-pump coronary bypass surgery [OPCAB]. A questionnaire was developed and all the local cardiac surgeons, who were either consultants or in waiting, were approached and requested to provide required information. This information was accepted as it was and tabulated to see the trend. Twenty one surgeons were approached. Nineteen surgeons were involved in coronary bypass surgery. OPCAB was performed by all with a varying frequency. Majority of surgeons felt that OPCAB was more difficult and the anastomosis not as accurate. They however felt that the procedure was beneficial for high risk patients. It was almost unanimous that off-pump technique was difficult to pass on to the trainess. OPCAB was performed by all the cardiac surgeons, doing coronary surgery, in Karachi. The practice is however not regular. This probably is due to not availability of avenues for CME locally. This would discourage surgeons to pass on the skill to the trainees and the interest may dwindle completely in future

Coronary artery bypasses surgery for acute coronary syndrome: off-pump versus on pump approach

Background: aim of this study was to compare the outcome of off-pump versus on-pump coronary artery bypass strategies in acute coronary syndromes setting

Methods and Results: consecutive patients for coronary artery bypass surgery [CABG] were reviewed. Cases with acute coronary syndrome [ACS] receiving emergency CABG surgery via midline sternotomy from June 2006 to September 2007 were evaluated. Altogether 27 patients were operated for ACS either off pump [OPCAB] n=16, or conventional on-pump [CPB] n-11. Seventy four grafts were performed in all with a mean of 2.74. Twenty patients between both groups had 3 or more grafts; with an aim of complete revascularization. Time from skin incision to culprit lesion revascularization was significantly reduced in OPCAB patients. OPCAB surgery led to a significant benefit in terms of less drainage loss, less transfusion requirement, less inotropic support, shorter ventilation time, and shorter intensive care unit stay

Conclusions: off-Pump strategies are associated with an improved hospital outcome for high-risk patients presenting acute coronary syndrome with or without cardiogenic shock

Thoracotomy without chest drain

To evaluate the outcome of thoracotomy without chest drain. Quasi experimental. From January 1999 to April 2004 in private Hospital. This is a retrospective study, performed at hospital over a period of 4 years from January 1999 till April 2004. All performed without chest intubation and the results were evaluated in the early and late post operative phases. All thoracotomies done with placement of chest tube were excluded. Out of 189 thoracotomies performed over a period of 4 years and 4 months, 161 patients underwent cardiothoracic surgical procedures without insertion of chest drain. Ages of the patients' ranged from 2 weeks to 65 years, with a mean of 28 years. There were 83 males and 106 females. Four patients developed surgical emphysema over the wound site. In one patient it continued to progress, compelling chest drain insertion. Postoperative recovery was quicker and the hospital stay remained short. It is safe to perform majority of thoracic procedures without retaining chest drain at the end. This expedites the recovery, save the patients from unnecessary pain and any other possible complications there of

Daycare cardiothoracic surgery

OBJECTIVE: The implications of Day Care Cardio Thoracic procedures in a developing country like Pakistan. DESIGN: Observational and prospective study. It was conducted at the Cardiac Surgery Unit, Civil Hospital Karachi, from July 1999 to December 2000. 35 patients with different methods of surgery were selected and the procedures performed on them were anterior mediastinotomy, permanent pace maker insertions, cervical sympathectomy, patent ductus arteriosus ligation, and eloiser's flaps. Out of 35 patients, only 3 were detained for over 24 hours solely for logistic reasons. All of them had been told to report back after 10 days and none of them had any wound infection or chest complication. Based on our experience, we found our protocol safe and effective in a selected group of patients. We recommend that quite a number of procedures can be done safely with economic advantages and better utilization of hospital resources without sacrifying the quality of health services

Transfusion practices for cardiac surgical patients at cardiac surgery, CHK

It is a well established fact that homologous blood transfusion is a practice that needs to be discouraged as a principal. Due to hazards of transmission of blood related diseases strict criteria were established for use of homologous blood transfusion or blood products. The aim was to have surgery without any transfusion or else minimum possible units. Altogether 63 patients had open-heart surgeries. Pre operative Hb ranged from 10-14 gm/dl average. Blood loss was less than 500 ml. Post operative and pre discharge Hb was 1013 gm /dl: A total of 23 patients were transfused blood from 1-2 units, commonest indication for transfusion was symptomatic patients due to borderline Hb. Altogether 6 units per patient were arranged but on average 5 units or less per patient were used. We feel that preoperative tratment can save more transfusions. We will further discuss the possible suggestions whereby we plan to reduce our transfusion indications further