ABSTRACT
Objective: To compare mean per-operative flow capacity between skeletonized and pedicled left internal mammary artery [LIMA] in patients undergoing coronary artery bypass grafting [CABG] surgery
Study Design: Randomized control trial
Place and Duration of Study: Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFIC-NIHD], Rawalpindi, Pakistan from February to August, 2013
Methodology: Patients undergoing CABG for coronary artery disease, under 80 years, excluded by the exclusion criteria; and fulfilling the inclusion criteria were randomly assigned to two groups of 70 each. One group underwent skeletonized and the other underwent pedicled technique of LIMA harvesting. Free flow was checked just before anastamosis of each LIMA to the LAD, manually in blood flow in ml per minute during cardiopulmonary bypass by allowing it to bleed into a 100 ml container over 20 seconds. A specialized proforma was used to record the age, gender, weight, disease, type of IMA used, and free flow of the IMA. Data was analyzed using SPSS 18
Results: The mean age of the patients was 57.16 years in 40 patients, ranging from 36 to 75 years. Disease pattern analysis showed 5%, 10.7% and 84.3% single, double and triple vessel coronary artery disease, respectively. There was significantly higher free flow in the skeletonized group than the pedicled group [p=0.04]
Conclusion: Skeletonized IMA had superior flow to pedicled IMA in addition to its traditional proven advantages, which justifies its further use as a conduit for myocardial revascularization
ABSTRACT
To determine the efficacy of topical application of Tranexamic acid in controlling postoperative bleeding in open-heart surgery. Double blind randomized control trial. Departments of Cardiac Surgery and Intensive Care of Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFIC-NIHD], Rawalpindi, Pakistan, from May to October 2011. A total of 100 consecutive adult patients fulfilling the inclusion criteria undergoing elective on-pump cardiac surgeries were randomly divided in groups [A] and [B]. A study solution that contained 2.5 g of Tranexamic acid in 250 ml normal saline in group-A and equal amount of normal saline [placebo] in group-B was poured in the pericardial cavity over the mediastinal tissues before sternal closure. Postoperative bleeding was measured in both groups for 24 hours in the cardiac surgical ICU. Efficacy of Topical Tranexamic Acid / Placebo was measured in terms of mean postoperative bleeding in ml. Kindly again include these lines which seem to have been omitted in the final proof. There was significant difference in the mean postoperative bleeding within 24 hours among the two groups 340.1 +/- 112.4 ml in Tranexamic acid group vs. 665 +/- 187.28 ml in placebo group [p < 0.001]. Patients who did not have topical Tranexamic acid before chest closure had a significantly higher postoperative bleeding. Topical Tranexamic acid application is an effective and economical way for controlling non-surgical bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass
Subject(s)
Humans , Male , Female , Postoperative Hemorrhage/drug therapy , Tranexamic Acid/administration & dosage , Tranexamic Acid , Administration, Topical , Cardiac Surgical Procedures , Randomized Controlled Trials as TopicABSTRACT
To compare the effects of warm blood cardioplegia along with hot shot [non-cardioplegic blood based] at the end of ischemic time to warm blood cardioplegia without hot shot to assess resumption of effective electromechanical activity and need for internal electrical cardioversion as indicators of myocardial protection and preservation. Randomized control trial. The study was conducted at Armed Forces Institute of Cardiology [AFIC], Rawalpindi for a period of 10 months [March 2009 - Dec 2009]. Total 100 patients of coronary artery disease having coronary artery bypass grafting [CABG] surgery were equally and randomly divided into two groups using random numbers table. Group A [n=50], consisted of warm blood cardioplegia with non cardioplegic blood based hot shot and group B [n=50], consisted of warm blood cardioplegia only. The adequacy of myocardial protection techniques was assessed by noting the time interval [in seconds] between declamping of the ascending aorta and patient regaining electromechanical activity. Additional parameters were rhythm, use of internal cardiac defibrillation, inotropes, IABP requirement and ECG evidenced peri-op MI. Average age in group A was 56.98 +/- 9.47 years and in Group B it was 59.14 +/- 9.35 years. In group A there were 48 [96%] males and group B there were 43 [86%] males with p-value of 0.081. Comparison of preoperative variables of both the groups revealed no difference in cross clamp time [p=0.52], CPB time [p = 0.68] and endarterectomy [p=0.55]. The electromechanical activity [contractility of heart] returned within 7.53 +/- 2.09min in group A as compared to 9.81 +/- 2.6min in group B [p<0.001]. Significantly high frequency was observed for defibrillation [p=0.025], inotropic support [p=0.045] and IABP insertion [p=0.041] in group B as compared to group A. In CABG surgery the additional use of hot shot [non cardioplegic blood based] during cardiopulmonary bypass [CPB] is effective in myocardial protection and preservation by resuming early contractility of heart, benefit of no detrimental effects like dysrhythmias and less requirement of chemical or mechanical cardiac support
ABSTRACT
To determine the 30 days outcome measured in terms of morbidity and mortality in cases of ventricular septal defect [VSD] with increased pulmonary vascular resistance [PVR] managed with double flap patch closure. Case series. Armed Forces Institute of Cardiology [AFIC/NIHD], Rawalpindi, from December 2005 to December 2008. Forty patients with VSD having PVR 9.58 + 4.33 wood units underwent double flap patch closure. The patch was fenestrated as one half of the expected aortic annulus diameter. A separate flap patch 5 mm larger than fenestration was attached to superior upper one third margins of fenestration. The patch was placed with flap to open towards the left ventricular apex. Modified ultra filtration [MUF] was employed in every case and sildenafil was given postoperatively. The age of patients ranged from 1 to 28 years with a mean of 6.66 + 5.70 years. There were 22 males and 18 females. All patients were weaned off from inotropic and ventilatory support as earlier as possible postoperatively with intensive care unit [ICU] stay of 77.15 + 54.56 hours. Postoperative pulmonary artery pressures were reduced to 42.63 + 10.86 mmHg as compared to pre-operative pulmonary artery pressures of 88.3 + 15.2 mmHg. Postoperatively 11 patients with suprasystemic pulmonary artery pressures and desaturation went into pulmonary hypertensive crisis in which immediate 2D echo evidenced the functioning flap valve with right to left shunt. There was only one death [early] out of 40 patients with an overall mortality of 2.5% along with limited morbidity. Double flap patch is an inexpensive, easy to construct technique with low morbidity and mortality in cases of VSD with raised PVR