ABSTRACT
Abstract: during the last 10-15 years, coronary artery surgery without use of cardiopulmonary bypass has gained popularity. Although worldwide incidence of off-pump surgery has remained around 15% , retrospective studies have shown that off-surgery reduces the inflammatory response, mortality and morbidity associated with coronary artery surgery
Objective: to compare early postoperative outcome in patients undergoing coronary artery surgery with or without cardiopulmonary bypass
Methods: a prospective randomized control trial was conducted in Punjab Institute of Cardiology Lahore:-Two hundred consecutive patients. Undergoing coronary artery surgery were randomized in two groups. Group I included 107 patients who underwent coronary artery bypass grafting on CPB and Group II included 93 patients who underwent coronary artery bypass grafting without CPB. Critically ill patients with hemodynamic instability, previous cardiac surgery and patients needing concomitant cardiac procedure were excluded from the study. Incidence of early postoperative [within 30 days] mortality and morbidity [myocardial infarction, bleeding, stroke, arrhythmias, renal and pulmonary complications and infection] were compared among · two groups
Results: in group I, 96 [89.71%] patients were male and 11[10.29%] were female. In group 11, 81[87.09%] patients were male and 12 [12.91%] were female. There was no significant difference in age, preoperative ejection fraction and risk factors for coronary artery disease between two groups. Routine blood tests including Hb, ESR, LFTs, RFTs, Lipid profile, bleeding profile did not show any significant difference among both groups. There was no significant difference in 30 days mortality among two groups, 2.8% in CCABG as compared to 4.3% in OPCAB [p=0.492]. No significant difference in incidence of adverse post-operative cardiac outcomes as Ml [4 [3.7%] in CCABG vs. 7 [7.5%] in OPCABJ, use of intra-aortic balloon pump [2[1.9%] in CCABG vs. 2 [2.2%] in OPCAB] and low cardiac output syndrome [2[1.9%] in CCABG vs. 1 [1.0%] in OPCABJ was found among two groups. No significant difference was observed in amount of bleeding in both groups. The incidence of pulmonary, renal and neurological complications was similar in both groups. Data regarding ICU stay [5.07+3.88 in CCABG vs. 4.23+2.11 in OPCAB] and hospital stay [12.8+8.14 in CCABG vs. 11.55+5.83 in OPCAB] showed insignificant difference
Conclusion: our study has not shown superiority of OPCAB over CCABG with regards to early mortality and morbidity which is consistent with other RCT conducted worldwide. So cautious approach is needed in widespread adoption of OPCAB
ABSTRACT
Aortic valve disease is associated with eccentric or concentric left ventricular [LV] hypertrophy and changes in the LV mass. The relationship between LV mass and function and the effect of LV remodeling after aortic valve replacement [AVR], in patients with aortic valve disease needs evaluation, that is largely unknown in our population. The aim of this study was to evaluate the effect of AVR on LV remodeling, in patients with aortic valve disease. Fifty patients with aortic valve disease were studied using transthoracic echocardiography to assess LV mass before AVR and compared with early postoperative changes in the LV dimensions and function. LV mass was studied preoperatively and before discharge in 50 consecutive patients undergoing isolated aortic valve replacement. Out of fifty patients, 47[94%] were male and 03[6%] were female. Mean age of the patients was 40.42 years. 22 [44%] had isolated aortic stenosis [AS], 16 [32%] patients had isolated aortic regurgitation [AR] and 12 [24%] patients had mixed aortic valve disease [MAVD]. 02 [4%] patients died. LV mass regression was studied in all the patients. In group A, with aortic stenosis, LV regressed to 69.88 gm [mean] with maximum of 156.88 gms and minimum of 0.00 gms [SD 43.67 gms, p value=0.001]. In group B, with aortic regurgitation, LV mass regressed to 203.96 gms [mean] with maximum 453.79 gms and minimum of 45.65 gms [SD 95.33, p value=<0.001]. In group C, with mixed aortic valve disease, postoperatively LV mass regressed to 122.94 gms [mean] with minimum 9.57 and maximum of 224.75 gms [SD 69.53, p value=0.524]. There was significant early LV mass regression after aortic valve replacement in patients with pre existing aortic valve disease. However, it was noticed that LV mass regressed in all patients except no significant changes in LV wall thickness [hypertrophy]
ABSTRACT
This study was designed in order to determine the incidence and clinical variables affecting abdominal complications after open-heart surgery. We included all consecutive patients from 1st April 1997 to 31 March1999 undergoing open-heart surgery in this study. Case notes of 76 patients who had abdominal complications were reviewed. Seventy-six patients [2.5%] had 80 abdominal complications, which included gastrointestinal bleeding [40%], hepatic failure [5%], ileus [8.8%], acute abdomen [22.5%], pancreatitis [7.5%], ischemic bowel [8.8%], bowel perforation [5%] and acute acalculous cholecystitis [1.3%]. Overall mortality for patients with abdominal complications was 32.9%. Mortality for Ischemic bowel, bowel perforation and hepatic failure was 87.5%, 75% and 50% respectively. Of thirteen patients who underwent laparotomy, 3 had negative laparotomy, 2 had extensive irresectible ischemic bowel while 8 patients underwent definitive surgical procedures. Higher mortality for bowel perforation was attributed to delayed diagnosis. Out of 30 patients who had GI bleed only 3 had previous history of acid peptic disease. Patients on aspirin and warfarin together had a higher incidence of GI bleeding [p=0.05. We conclude that abdominal complications following open-heart surgery are not rare and carry a very high mortality. Ischemic bowel and delayed diagnosis of bowel perforation remain important causes of mortality