Post-operative atrial fibrillation; incidence after coronary after bypass graft surgery

Atrial fibrillation is the most common arrhythmia observed following Coronary Artery Bypass Graft surgery

Objectives: To determine the incidence of post-operative atrial fibrillation in patients undergoing coronary artery bypass grafting

Materials and Methods: Study Design: Non-randomized prospective

Setting: Cardiac Surgery Department of Multan Institute of Cardiology, Multan. Period: 20-1-2014 to 01-05-2015. A total number of four hundred and ninety [490] patients having age more than 40 years undergoing isolated coronary artery bypass graft surgery were included in the study. Data was analyzed in SPSS V20 software. Frequency and percentages were used for Atrial Fibrillation. To see the impact of AF on morbidity, patients developing AF was compared with those who do not develop Atrial Fibrillation post-operatively using independent sample t-test for quantitative variables. Chisquare test and Fischer's Exact test [whenever appropriate] was used to compare qualitative variables

Results: A total number of four hundred and ninety [490] patients were included in this study. There were more 431 males [88.0%] in this study. of the patients 71.6% were in LV Grade I before surgery. Incidence of post-operative atrial fibrillation was 13.5%. In 4.5% patients IABP was inserted due to hemodynamic instability. Ventilation time and hospital stay time was significantly higher in patients with AF postoperatively [p value 0.03 and 0.02 respectively]. But duration of inotropic support, post-op CKMB levels and IABP use were not significantly different in both groups

Conclusion: The incidence of post-operative Atrial Fibrillation is 13.5% according to this study. And these patients were associated with increased risk of morbidity

Aortic valve replacement; relation of aortic annulus measured by echocardiography and prosthesis size required

Precise determination of the size of aortic annulus is very important for the preoperative evaluation before aortic valve replacement

Objectives: to determine the preoperative prosthesis size using echocardiography in patients undergoing aortic valve replacement

Study Design: prospective observational study

Setting: Ch. Pervaiz Elahi Institute of Cardiology [CPEIC] Multan. Period: January 2013 to October 2014

Methods: [100 patients] Aortic annulus sizes were measured with TTE one week before surgery and with the help of sizer per-operatively. The data was analyzed by using SPSS V16. Quantitative variables were analyzed using mean and standard deviation and percentages were used for qualitative variables. Dependent sample t test was used to see accuracy of TTE in measuring aortic annulus size

Results: out of hundred patients, 84[84%] were male. Mean age of the patients was 33.77 +/- 13.17 years. 51% patients underwent isolated Aortic valve replacement; redo-operations were done only in 4% patients. In 96% patient's mechanical prosthesis was used and in 4% patient's boiprosthesis was used for valve replacement. We found no significant difference in Aortic annulus measured pre-operatively with the TTE [23.54 +/- 3.54] and measured per-operative with the sizer [23.96 +/- 3.36] with highly insignificant p-value 0.58.Aortic annulus size was almost same measured by these two techniques. Conclusion: Aortic annulus size measured with TTE helps to arrange the optimum size prosthesis before aortic valve replacement surgery

New modification of modified bentall procedure [a single centre experience]

Background and Objectives: Modified Bentall procedure has become a gold standard in the treatment of combined aortic root and aortic valve diseases. Bleeding is an important predictor of morbidity and mortality after the Bentall operation. Our objective was to evaluate the early outcomes of Modified Button-Bentall procedure with cuff technique for aortic root replacement surgery regarding hemostasis

Methods: A total number of 32 patients who underwent elective Bentall operation from January 2008 to December 2014 were included in the study. In 18 patients [Group I] modified Button-Bentall procedure with formation of cuff was used and in 14 patients [Group II] Modified Button technique without cuff formation was used for aortic root replacement. Data was analyzed using SPSS V16. Chi-square test, Fisher's Exact test and independent sample t-test was used to analyze Qualitative and Quantitative variables

Results: Three patients in Group II and two patients in group I was in congestive cardiac failure pre-operatively. Out of thirty two patients two patients were having Aortic root dissection one in each group. Total bypass time and cross-clamp time were significantly high in Group I. There was no significant difference regarding duration of inotropic support, ventilation time, ICU stay and hospital stay time in patients of Group I and Group II. But post-op Chest drainage was very high in Group II 1158+451.25 ml versus 488.89+168.27 ml in group I [p-value <0.0001]. There was one in hospital death in Group II

Conclusions: Formation of cuff of remnant of aorta during proximal anastomosis results in significant reduction in post-operative bleeding and was better in hospital outcomes