Off pump coronary artery surgery and intraoperative safety-experience at AFIC/NIHD, Rawalpindi

Coronary Artery Bypass Grafting [CABG] with cardiopulmonary bypass [CPB] on one hand allows controlled haemodynamics with superior graft quality while on the other hand carries inherent risks of CPB which has renewed interest in Off-pump coronary artery bypass [OPCAB]. Haemodynamic instability and intraoperative dysrythmias are major procedural complications of OPCAB, threatening conversion to emergency on-pump surgery. The purpose of this study was to compare intraoperative dysrythmias and inotropic use for haemodynamic stabilization during OPCAB surgery against conventional CABG. Consecutive CABG cases operated between 1[st] June 2003 and 31[st] May 2006 were included while conversions were excluded. Primary end points were analyzed using chi square and t test and values described in percentages, means and probability [p value]. Six hundred and eighty-four cases were divided in group-A [on-pump, n=574] and B [OPCAB, n=97]. Conversion rate was 11.8%. Intraoperative dysrythmias [A, 3.5%, B, 15%, p<0.0001] and use of inotropic support was higher in group-B [A, 15.3%, B, 30.3%, p<0.0001]. Actual mortality in group-B was higher than the predictive value [A, 3.8%, B, 3.6%, Predictive value 3-5% and 0-3% respectively]. OPCAB leads to higher frequency of dysrythmias and inotropic use intraoperatively, highlighting lower procedural safety over conventional CABG

Right ventricular myxoma with heart failure

Cardiac myxomas are histologically benign tumors but they may be lethal because of their strategic position. These are mostly located in the left atrium and uncommonly in the right atrium. We report a case of a large right ventricular myxoma presenting with heart failure

Radial artery as a grafting surgery: Early experience at AFic / NIHD

The long-term patency of vein grafts in the coronary circulation has been poor. By contrast, the left internal thoracic artery [LITA] graft to left anterior descending coronary artery [LAD] has been associated with excellent patency and good clinical results. The revival of radial artery [RA] as a graft has offered another source of arterial conduit in addition to the use of right internal thoracic artery [RITA]. We evaluated our early experience with the use of RA as a conduit for coronary artery bypass grafting [CABG] surgery to establish its safety and efficacy. we studied 606 consecutive patients from January 2003 to December 2003 who underwent CABG surgery at our institute. Radial artery was used as a conduit 'in 214 patients. Data was collected prospectively. In the radial artery group, the age range was 27 - 72 years, mean age 49.5 years. 136 [64%] of the patients had diabetes, only 7 [3.27%] patients were females. 8 [3.73%] patients had left ventricular ejection fraction of less than 30%, 146 [68.22%] patients had EF of 30-45% and rest were with good left ventricular function. 23 [10.74%] patients were classified as unstable/urgent. The conduits included were 206 left internal thoracic arteries, 26 right internal thoracic arteries and 214 radial arteries and 170 were vein grafts. Average number of grafts per patient was 2.87. Top ends of the free arterial grafts as well as all the vein grafts were anastamosed directly to the ascending aorta. Patients were followed up to 6 weeks, 24 weeks and then 6 monthly thereafter. Complications included intra operative or post operative myocardial infarction in 6 [2.8%] patients, sternal wound infection in 4 [1.86%] patients, reoperation for excessive bleeding 17 [7.94%] patients. 14 [6%] patients required intra aortic balloon pump support, 46 [21%] required inotropic support. The incidence of hand complication was 7% [15 patients]. The overall mortality rate in radial artery group was not much different from the non-radial artery group of patients undergoing CABG surgery in our settings. Conclusions: Radial artery may be used as a conduit for coronary artery bypass grafting operation with confidence as regards its safety