ABSTRACT
Blood transfusion is an integral part of cardiac surgery; however, transfusion of blood and blood products has inherent hazards. Avoidance of blood transfusion during cardiac surgery eliminates the hazards of blood transfusion and improves the outcome. This study compares the post-operative outcome of patients who underwent cardiac surgery without blood transfusion with those who required multiple blood transfusions.METHODSPatients who underwent cardiac surgery in a unit in Department of Cardiothoracic and Vascular Surgery (CTVS), SSKM Hospital, between January 2017 to December 2018 were studied retrospectively. The study population was divided into 2 groups. Those patients who underwent cardiac surgery and did not receive blood transfusion were included in Group A (n=68) and those who received multiple blood transfusion were included in Group B (n=340). Statistical data was analysed.RESULTSThe recovery of patients in terms of mechanical ventilation time (mean, 8.2 vs 12.5 hrs.), length of Intensive Care Unit (ICU) stay (mean, 1.5 vs 3.3 days) was significantly shorter in group A patients than group B. The length of hospital stay also was significantly less in group A patients (mean 5.2 vs 7.3 days, p=<0.0001). Patients with history of smoking, chronic obstructive pulmonary disease (COPD), had higher incidences of blood transfusions (p-0.003, 0.001 respectively). There was lesser incidence of surgical site infection and respiratory complications in Group A patients, but it was not statistically significant. However, incidence of haematuria was more in Group B patients which was clinically significant (p = 0.011). There was no incidence of renal failure, mediastinal bleeding requiring re-exploration, jaundice and mortality in Group A patients.CONCLUSIONSCareful surgical and perfusion techniques, with meticulous haemostasis should be performed in all patients of cardiac surgery. Elimination of blood during cardiac surgery augments faster recovery of patients.
ABSTRACT
Cardiovascular diseases (CVD) are the leading cause of death globally including India. Ischemic heart disease is the most common cause of death. There is a sharp rise in Off Pump Coronary Artery Bypass Surgery (OPCAB), which increases cardiac enzymes like Troponin T, that is used as prognostic guide. In triple vessel disease 40 to 50% cases involve right ventricle, therefore along with left ventricular ejection fraction (LVEF), Tricuspid Annular Plane Systolic Excursion (TAPSE) can be used as a prognostic guide, which can be measured by noninvasive doppler echocardiography.METHODSPatients with specific criteria who underwent OPCAB surgery from January 2018 to March 2019 were studied. Both pre- and post-operative (14-16 hours) Troponin T (TropT) sensitivity tests were done and only preoperative Trop T negative patients were selected for the study. Postoperative patients were divided into 2 groups, TropT positive and negative. Echocardiography was done on the day before surgery, on postoperative day 5 (POD5) and postoperative day 30 (POD30). Results were compared between the two groups.RESULTSAmong 88 patients thus selected, 34 patients (38.63%) were Trop T positive, and 54 patients (61.37%) were Trop T negative. On post-operative day 5, increase in brain natriuretic peptide (BNP), decrease in TAPSE and decrease in haemoglobin were significant in Trop T positive group. Need for ventilation and postoperative hospital stay were significantly prolonged in positive groups. In POD30, decrease in albumin, decrease in LVEF and TAPSE all are significant in TropT positive group.CONCLUSIONSIt is important to determine the prognosis of OPCAB patients in early postoperative period. Troponin T has a significant prognostic value in OPCAB patients supported by LVEF and TAPSE.