Department Of Cardiac Surgery Research Articles

Sex-Based Difference in Aortic Dissection Outcomes: A Multicenter Study.

Type A Acute Aortic Dissection (TAAAD) repair is a surgical emergency associated with high morbidity and mortality. Registry data have noted several sex-specific differences in presentation with TAAAD which may account for the differences in men and women undergoing surgery for this condition. A retrospective review of data from three departments of cardiac surgery (Centre Cardiologique du Nord, Henri-Mondor University Hospital, San Martino University Hospital, Genoa) between January 2005 and 31 December 2021 was conducted. Confounders were adjusted using doubly robust regression models, a combination of regression models with inverse probability treatment weighting by propensity score. 633 patients were included in the study, of which 192 (30.3%) were women. Women were significantly older with reduced haemoglobin levels and pre-operative estimated glomerular filtration rate compared to men. Male patients were more likely to undergo aortic root replacement and partial or total arch repair. Operative mortality (OR 0.745, 95% CI: 0.491-1.130) and early postoperative neurological complication results were comparable between the groups. The adjusted survival curves using IPTW by propensity score confirmed the absence of a significant impact of gender on long-term survival (HR 0.883, 95% CI 0.561-1.198). In a subgroup analysis of women, preoperative levels of arterial lactate (OR 1.468, 95% CI: 1.133-1.901) and mesenteric ischemia after surgery (OR 32.742, 95% CI: 3.361-319.017) were significantly associated with increased operative mortality. The advancing age of female patients alongside raised preoperative level of arterial lactate may account for the increasing preponderance among surgeons to perform more conservative surgery compared to their younger male counterparts although postoperative survival was similar between the groups.

Potassium Imbalance Leading to Arrhythmias in Patients Undergoing Cardiac Surgery on Cardiopulmonary Bypass

Objective: To determine the frequency of factors that cause potassium imbalance in patients with postoperative arrhythmias after cardiac Bypass surgery Material and methods: During the time period of 2 November 2018 through 10 January 2020, 100 patients with heart disease receiving open-heart surgery were enrolled in a prospective observational research conducted by the cardiac surgery department at the Punjab Institute of Cardiology in Lahore. Both genders of age 17-70 years were included and patients with cyanotic heart disease congenital heart disease, previous cardiac surgery and urgent CABG were excluded. Results: Our results showed that of 100 patients, 59 (59%) were male and 41 (41%) were female and the mean age was14.243 ± 50.12 years. 6 patients had preexisting renal failure and 9 had postoperative renal failure. Overall potassium imbalance was noted in 39 patients, 33 were hypokalemic and 6 were hyperkalemic and the mean potassium with S.D was 3.95±0.83 and 37 had postoperative arrhythmias out of which 18 (54.5%) were hypokalemic and 2 (33.3%) were hyperkalemic. Preoperative drugs, preexisting renal failure, CPB time, aortic cross clamp time, intraoperative potassium levels, time on ventilation, postoperative urine output, potassium infusion, postoperative renal failure, arrhythmias and total hospital stay were found to be statistically significant. Conclusion: Potassium imbalance post-cardiopulmonary bypass is major factor that may lead to increased risk of postoperative arrhythmias. Keywords: Potassium imbalance, cardiopulmonary bypass, postoperative arrhythmias, renal failure, hypokalemia

Comparison of Peroperative Venous Grafts Number and Distribution of Distal Venous Grafts

Introduction: Coronary artery bypass grafting effectively relieves signs and symptoms of myocardial ischemia. Coronary artery bypass grafting (CABG) surgery aims to restore adequate blood supply to the ischemic heart and the success of the operation depends mainly upon the patency of the grafts. A major contributing factor to the early atherosclerotic process is damage to the vessel wall, specially endothelial injury that occurs during the conventional harvesting of the vein, using high-pressure distension. Objective: To determine the comparison of peroperative venous grafts number and distribution of distal venous grafts. Materials and Methods: This comparative cross-sectional study was carried out at the department of cardiac surgery in National Heart Foundation Hospital & Research Institute. The period of study was from January, 2019 to September, 2020 and purposive sampling method was applied for this study. The study population was 80, with two groups having 40 patients each. Grouping of patients were done by purposive sampling method and all patients underwent elective coronary artery bypass graft in 2015. These groups of patients again investigated through coronary computed tomography angiogram in 2020 for evaluation of saphenous vein patency and occlusion rate. Data was collected by using a standardized semi-structured questionnaire, face to face interview and hospital records. Results: Among the study population mean age in group A was 59.38±7.43 years and in group B was 58.70±8.27 years. The difference in age between two groups was not statistically significant (p=0.702). There was no statistical significance of gender in between the two study groups (p=0.762). The comparison of the presence of Chest pain (p=0.799), Dyspnea (p=0.262), Palpitation (p=0.633) in group A and B patients were statistically not significant (p>0.05). The number of venous grafts of group A was 3.65±0.74 & group B was 3.58±0.55 where the finding was statistically ............

Early Outcome of Coronary Artery Bypass Grafting in Obese and Non Obese Patients

Objective: To determine the impact of body mass index (BMI) on short-term outcomes like; renal failure, prolonged ventilation and mortality after CABG surgery. Methodology: This prospective comparative study was conducted at the Cardiac Surgery Department, Pervaiz Elahi Institute of Cardiology, Bahawalpur from February to December 2021. A total of 148 patients were enrolled after taking written consent and data was collected through predesign proforma sheets, including; clinical history, investigation and early outcomes in term of (renal failure, prolonged ventilation, and mortality). SPSS 23 was used to analyze data with statistically significant p-value < 0.05. Results: The findings showed that average age of research participants were 57.14 ± 3.07 (age range 30-73 years) and 121 (81.76%) male compared with 27(18.24%) female patients were enrolled with insignificant p-value of 0.730. In this study prolonged ventilation was found in 5(6.76%) obese and 8(10.81%) non-obese patients with insignificant p-value of 0.070. Renal Failure was found in 2 (2.70%) obese and 8 (10.81%) non-obese patients with significant p-value of 0.02 and mortality in 4(5.41%) obese and 2 (2.70%) non-obese patients with significant p-value of 0.0482. Conclusion: The results of the current investigation demonstrated that an obese BMI was a reliable indicator of morbidity or mortality following CABG.

Comparison of the Effect of Inhalation and Intermittent Inhalation-Exhalation Incentive Spirometry on Dyspnea Severity and Atelectasis in Patients undergoing Coronary Artery Bypass Graft

Background: Dyspnea and atelectasis after Coronary Artery Bypass Graft (CABG) are common and need nursing attention. Inhalation and exhalation incentive spirometry is recommended for preventing alveolar collapse and atelectasis. Objectives: This study aimed to compare different methods of incentive spirometry on dyspnea severity and atelectasis of the patients undergoing CABG. Methods: This randomized clinical trial study was conducted on 66 patients undergoing CABG admitted to the Intensive Care Unit (ICU) of Cardiac Surgery Department in Hamadan, Iran, in 2020. The patients were selected through convenient sampling and were divided into two groups through block permutation: inhalation incentive spirometry and intermittent inhalation-exhalation spirometry. Both groups performed incentive spirometry according to the instructions they had received for four days. Then, they were examined for dyspnea and atelectasis using the Borg scale and chest x-ray, respectively. Results: During the intervention, dyspnea significantly decreased in the intermittent inhalation-exhalation group relative to the inhalation group (P<0.05). Most patients in both inhalation (63.6%) and intermittent inhalation-exhalation (65.6%) groups had atelectasis; however, no significant differences were observed between the two groups (P=0.867). Conclusion: Incentive spirometry via intermittent inhalation-exhalation method was more effective on dyspnea compared to the inhalation method. Therefore, this method is recommended to patients and nurses to reduce pulmonary complications after CABG

Commentary: Routine use of percutaneous femoral cannulation in minimally invasive cardiac surgery.

Journal Article Accepted manuscript Commentary: Routine use of percutaneous femoral cannulation in minimally invasive cardiac surgery Get access F Bakhtiary, MD PhD, F Bakhtiary, MD PhD Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany Corresponding Author: Farhad Bakhtiary, MD PhD, Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Venusberg Campus 1, Bldg. 22, Room EG/048, 53127 Bonn, Tel: +49 228 287-14190, Fax: +49 228 287-14195. E-Mail: farhad.bakhtiary@ukbonn.de Search for other works by this author on: Oxford Academic PubMed Google Scholar S Salamate, MD, S Salamate, MD Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany Search for other works by this author on: Oxford Academic PubMed Google Scholar A Bayram, MD, A Bayram, MD Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany Search for other works by this author on: Oxford Academic PubMed Google Scholar A El-Sayed Ahmad, MD PhD A El-Sayed Ahmad, MD PhD Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany Search for other works by this author on: Oxford Academic PubMed Google Scholar European Journal of Cardio-Thoracic Surgery, ezad079, https://doi.org/10.1093/ejcts/ezad079 Published: 09 March 2023 Article history Received: 15 February 2023 Accepted: 01 March 2023 Published: 09 March 2023

From Leonardo to the Valsalva graft: the physics behind valve-sparing aortic root replacement.

Journal Article Accepted manuscript From Leonardo to the Valsalva graft: the physics behind valve-sparing aortic root replacement Get access Giacomo Murana, MD, PhD, Giacomo Murana, MD, PhD Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna Corresponding author: Dr. Giacomo Murana, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. Tel: 0039 051 2143361 Fax: 0039 051 345990. e-mail: g.murana@hotmail.com; giacomo.murana@aosp.bo.it Search for other works by this author on: Oxford Academic PubMed Google Scholar Davide Pacini, MD, PhD Davide Pacini, MD, PhD Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di BolognaDepartment of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna Search for other works by this author on: Oxford Academic PubMed Google Scholar European Journal of Cardio-Thoracic Surgery, ezad094, https://doi.org/10.1093/ejcts/ezad094 Published: 13 March 2023 Article history Received: 06 March 2023 Accepted: 11 March 2023 Published: 13 March 2023

Surgical treatment for obstructive hypertrophic cardiomyopathy: a five-year single-center experience of 421 cases

Objectives: To examine the short-term and mid-term effects of surgical treatment of obstructive hypertrophic cardiomyopathy (HCM) in one center. Methods: The perioperative data and short-term follow-up outcomes of 421 patients with obstructive HCM who received surgical treatment at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University from January 2017 to December 2021 were analyzed retrospectively. There were 207 males and 214 females, aged (56.5±11.7) years (range: 19 to 78 years). Preoperative New York Heart Association (NYHA) classification included 45 cases of class Ⅱ, 328 cases in class Ⅲ, and 48 cases in class Ⅳ. Fifty-eight patients were diagnosed with latent obstructive HCM and 257 patients had moderate or more mitral regurgitation with 56 patients suffering from intrinsic mitral valve diseases. All procedures were completed by a multidisciplinary team, including professional echocardiologists involving in preoperative planning for proper mitral valve management strategies and intraoperative monitoring. A total of 338 patients underwent septal myectomy alone, and 59 patients underwent mitral valve surgery along with myectomy. A single transaortic approach was used in 355 patients, and a right atrial-atrial septal/atrial sulcus approach was used in 51 other patients. Long-handled minimally invasive surgical instruments were used for the procedures. Student t test, Wilcoxon rank sum test, χ2 test or Fisher exact test were used to compare the data before and after surgery. Results: The aortic cross-clamping time of septal myectomy alone was (34.3±8.5) minutes (range: 21 to 94 minutes). Eighteen patients had intraoperative adverse events and underwent immediate reoperation, including residual obstruction (10 patients), left ventricular free wall rupture (4 patients), ventricular septal perforation (3 patients), and aortic valve perforation (1 patient). Four patients died during hospitalization, and 11 patients developed complete atrioventricular block requiring permanent pacemaker implantation. After discharge, 384 (92.1%) patients received a follow-up visit with a median duration of 9 months. All follow-up patients survived with significantly improved NYHA classifications: 216 patients in class Ⅰ and 168 patients in class Ⅱ (χ2=662.73, P<0.01 as compared to baseline). At 6 months after surgery, follow-up echocardiography showed that the thickness of the ventricular septum ((13.6±2.5) mm vs. (18.2±3.0) mm, t=23.51, P<0.01) and the peak left ventricular outflow tract gradient ((12.0±6.3) mmHg vs. (93.4±19.8) mmHg, 1 mmHg=0.133 kPa, t=78.29, P<0.01) were both significantly lower than baseline values. Conclusion: The construction of the surgical team (including echocardiography experts), proper mitral valve management strategies, identification and management of sub-mitral-valve abnormalities, and application of long-handled minimally invasive surgical instruments are important for the successful implementation of septal myectomy with satisfactory short-and medium-term outcomes.

Incidental Discovery of a Cardiac Thrombus Mimicking a Right Atrial Myxoma in a Young Female Patient – A Case Report

Abstract Introduction Cardiac masses are at the attention of health specialists since the development of echocardiography. Even though imaging is an excellent tool for diagnosis, the clinical presentation, risk factors, and hemodynamic status of the patients are important in establishing the diagnosis and subsequent management. The purpose of this presentation is to assess the difficulty of diagnosis in the case of an intracardiac mass and its therapeutic management. Case report A 29-year-old female with paresthesia in the left arm and a systolic tricuspid murmur underwent echocardiography, which revealed a mass of 35/20 mm in the right atrium. Due to the high embolic risk, the patient was referred to the cardiac surgery department and underwent surgical removal of the cardiac mass, which presented the macroscopical aspect of a myxoma. However, the histopathological examination revealed a right atrial thrombus. Conclusion Right heart thrombi represent a challenging diagnosis that involves a multidisciplinary team for the diagnosis and treatment of the patient.

THE EFFECTS OF PULMONARY HYPERTENSION ON OUTCOMES OF MITRAL VALVE SURGERY

This study aimed to assess the effect of pulmonary hypertension on the outcomes of mitral valve surgery in terms of operative mortality, dependence on inotropic agents, duration of ventilation, length of ICU, and hospital stay. This comparative study was conducted at the Department of Cardiac Surgery, Faisalabad Institute of Cardiology, from January 2018 to July 2018. A total of 138 cases (69 in each group) were included in the study. Patients with mild or moderate PHT were enrolled in group A, and patients with severe PHT were in group B. Required surgery was performed. Outcomes, including operative mortality, duration of mechanical ventilation postoperatively, dependence on inotropic agents in ICU, and length of stay in ICU as well as hospital, were noted in both groups during intensive care stay. Difference between the two groups in terms of mean duration of mechanical ventilation (10.58±2.79 vs. 10.96±3.42 hours; p-value=0.480), mean duration of inotropic support (8.55±2.75 vs. 9.45±3.92 hours, p-value=0.122), mean length of ICU stay (2.97±1.34 vs. 3.32±1.40 days, p-value=0.138) and mean length of hospital stay (12.3±3.8 vs. 12.6±4.1 days, p-value=0.684) was not statistically significant. In patients with severe pulmonary hypertension, mitral valve replacement was found equally safe compared to those with mild to moderate pulmonary hypertension.

Immediate results of combined coronary bypass surgery and aortic valve replacement with incomplete and complete myocardial revascularization

Introduction. Coronary heart disease and aortic valve stenosis still occupy a leading position among cardiovascular diseases. Against the background of an increase in life expectancy, patients with a combined pathology of the heart are increasingly appearing. Without surgical treatment, such patients have an unfavorable prognosis of life with a high mortality rate. Simultaneous surgical correction of coronary heart disease and aortic valve stenosis is a treatment method that can improve the prognosis and prolong the life of a patient. At the same time, combined interventions remain higher-risk operations compared to isolated aortic valve replacement and isolated coronary artery bypass grafting.The Objective was to evaluate the effect of incomplete and complete myocardial revascularization on the immediate results of surgical correction of combined pathology of the aortic valve and coronary arteries.Methods and Materials. For the period from 2017 until June 2022, 62 aortic valve replacement operations in combination with coronary artery bypass grafting were performed in the cardiac surgery department of the Leningrad Regional Clinical Hospital. The operated patients were divided into two groups. The group 1 included (n=32) patients who underwent aortic valve replacement and complete myocardial revascularization. The group 2 included patients (n=30) who underwent aortic valve replacement and incomplete myocardial revascularization.Results. Postoperative periods in both groups, according to the structure of early postoperative complications, are generally similar. The mortality rate in both groups did not exceed the predicted mortality rate and corresponded to the data of various literary sources.Conclusion. Our observation data showed that the mortality rate in the early postoperative period, in combined operations, does not depend on the completeness of revascularization in combined operations of coronary artery bypass grafting and aortic valve replacement. It is necessary to perform as complete myocardial revascularization in combined operations as technically feasible and appropriate in a clinical situation.

Postoperative delirium and its influencing factors in elderly patients with lung cancer in the intensive care unit.

In 2020, there were 2,206,771 new cases of lung cancer worldwide, ranking first in mortality rate postoperative delirium (POD) is a common surgical complication and typically occurs 1-3 days after surgery which leads to prolonged hospital stay. The currently available research on POD in elderly patients was mainly carried out in cardiac surgery, orthopedic, and gastroenterology departments. It is necessary to study the incidence and risk factors of delirium in intensive care unit (ICU) elderly patients after lung cancer surgery. This study is a single-center and singe-arm observational study which examined the incidence of and factors affecting POD in elderly patients with lung cancer in ICU at our center from September 2019 to May 2020. 22 relevant variables including arterial oxygen partial pressure, postoperative sedative drug use, and other data were collected. The Confusion Assessment Method of Intensive Care Unit was used to assess the occurrence of POD, the Chinese version of the Richards-Campbell Sleep Questionnaire was used to assess patients' postoperative sleep quality, and the Mini-Mental State Examination was used to assess patients' preoperative cognitive level. Univariate and multivariate logistic regression analyses were conducted to identify the factors affecting POD in elderly ICU patients with lung cancer. Among the 208 elderly ICU patients who underwent surgery for lung cancer, 32 (15.38%) had POD. The results showed that postoperative blood oxygen level, preoperative cognitive level score and postoperative sleep quality score in delirium group were significantly lower than those in non-delirium group (P values were 0.002, 0.000, 0.000, respectively). The proportion of previous coronary heart disease and postoperative sedation use in delirium group was significantly higher than that in non-delirium group (P=0.008 and 0.008, respectively). It was observed that the preoperative Mini-Mental State Examination (MMSE) score and postoperative Richards-Campbell Sleep Questionnaire (RCSQ) score of the delirium group were significantly lower than those of the non-delirium group, and this trend was still observed after adjusting for influencing factors. It is suggested that the difference of cognitive level in elderly lung cancer population has a significant effect on the occurrence of POD. In clinical work, we should pay more attention to patients with preoperative cognitive impairment, hypoxic state, and postoperative sleep disturbance.

CRT-300.18 Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: Experience at a Centre Without On-Site Cardiac Surgery Department Connected With National Reference Unit. Five Years’ Experience

CRT-300.18 Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: Experience at a Centre Without On-Site Cardiac Surgery Department Connected With National Reference Unit. Five Years’ Experience

Cross-sectional survey of preoperative nutritional status of cardiac surgery patients in southwest China

To investigate the preoperative nutritional status of cardiac surgery patients in southwest China, analyze the incidence and characteristics of nutritional risk, and provide basis for establishing a standardized individualized nutritional intervention program for cardiac surgery patients. A cross-sectional survey was conducted on the nutritional status and intervention status of preoperative patients in cardiac surgery department of 23 general hospitals in Yunnan, Guizhou, Sichuan and Chongqing districts. At 00: 00 on July 7, 2022, the patients aged > 18 years old in cardiac surgery departments of the above hospitals who planned to undergo surgical treatment were enrolled as the survey objects to investigate the nutritional status on July 6, 2022 (the survey date), including basic information (general information, nutrition indicators, etc.), nutrition screening and evaluation (nutrition risk screening and organ support, etc.), nutrition treatment (nutrition supplement methods and prescriptions, etc.) and nutrition awareness of medical staff. The 126 questionnaires were collected, of which 125 were valid (99.2%). (1) Basic information: of the 125 patients, 67 patients were male (53.6%) and 58 patients were female (46.4%). The age ranged from 19 years old to 86 years old, with an average of (53.13±14.74) years old. Body mass index (BMI) was (22.21±3.78) kg/m2. The age and BMI of men were significantly higher than those of women [age (years old): 56.63±13.34 vs. 49.09±15.35, BMI (kg/m2): 22.74±3.86 vs. 21.59±3.61, both P < 0.05]. Of the 125 patients, 75 had valvular disease and 50 were with non-valvular diseases, which mainly included congenital heart disease [19 cases (15.2%)], aortic dissection [13 cases (10.4%)], coronary heart disease [12 cases (9.6%)], etc. The course of disease was 0.5 hour to 36 years, of which 93 patients (74.4%) were more than 6 months and 32 patients (25.6%) were equal to or less than 6 months. The proportion of female patients with disease duration > 6 months was significantly higher than that of male patients [87.9% (51/58) vs. 62.7% (42/67), P < 0.01]. The basic diseases mainly included hypertension [38 cases (30.4%)], coronary heart disease [12 cases (9.6%)], diabetes [7 cases (5.6%)], chronic obstructive pulmonary disease [COPD, 6 cases (4.8%)], etc. Among 125 patients, total protein (TP) < 60 g/L in 24 cases (19.2%), albumin (Alb) < 40 g/L in 64 cases (51.2%), anemia [male hemoglobin (Hb) < 120 g/L, female Hb < 110 g/L] in 33 cases (26.4%). A total of 60 cases of prealbumin data were collected, of which 23 cases (38.3%) were less than 200 mg/L. (2) Nutrition screening and assessment: 33.6% of the 125 patients did not undergo routine nutrition screening after admission, including the provincial and municipal tertiary hospitals. Among the 83 patients undergoing nutritional screening, 41 (32.8%) were at nutritional risk. Further analysis of patients with nutritional risk showed that of the 41 patients, 20 were male (48.8%) and 21 were female (51.2%); 27 cases (65.9%) was with valvular diseases and 14 cases (34.1%) was with non-valvular diseases; the course of disease was more than 6 months in 30 cases (73.2%), and ≤ 6 months in 11 cases (26.7%). Statistical comparison of the above 83 patients showed that women, basic disease, long term-valvular disease, anemia, low TP, and low Alb before operation were more prone to innutrition. (3) Nutritional therapy: of the 125 patients, 5 were receiving mechanical ventilation (4.0%) and 2 were using vasoactive drugs (1.6%); there were 5 cases with gastrointestinal dysfunction (4.0%), mainly manifested as abdominal distension, abdominal pain, constipation and diarrhea. One patient was treated with enteral nutrition through gastric tube combined with parenteral nutrition support, 124 patients were fed orally, and an irregular phenomenon of injecting amino acid fat emulsion through peripheral vein in 2 patients. (4) Nutrition awareness of medical staff: 124 (99.2%) of the 125 patients had a nutrition department in their hospital; 71 cases (56.8%) received nutrition education, of which 37 cases (52.1%) were consulted by the nutrition department. Of all the cases, only 38 (30.4%) were consulted by the nutrition department, of which 1 (2.6%) did not receive nutrition education after consultation. At present, the incidence of preoperative malnutrition in patients undergoing cardiac surgery is high in southwest China. The incidence of malnutrition in patients with basic diseases, long term-valvular disease, low TP, low Alb and anemia before operation is higher, and the incidence of malnutrition is hidden in women. The course of disease of women is longer than that of men at the time of treatment, and malnutrition is more likely to occur. The attending physicians should pay attention to the above groups. It is necessary to establish a standardized individualized nutritional intervention program and apply it to actual clinical diagnosis and treatment, so as to ultimately improve the prognosis of patients undergoing cardiac surgery and increase the benefits of patients in treatment.

CRT-700.46 Safety and Feasibility of MitraClip® Program at Centres Without On-Site Cardiac Surgery Department

CRT-700.46 Safety and Feasibility of MitraClip® Program at Centres Without On-Site Cardiac Surgery Department

Comparison of Dacron Band versus Segmental Annuloplastyin Treatment of Tricuspid Valve Repair

Objective: The objective of this study was to compare outcome of Dacron Band versus Segmental Annuloplasty in treatment of TV repair. Study Design: This was a randomized controlled trial. Place and Duration: This study was conducted at the Cardiac surgery Department, PIC, Jail Road, Lahore from 25 October 2021 to 25 Oct, 2022. Methodology:A total of 148 patients were enrolled in this study and divided into two groups equally. For categorical data like gender, and grades of Tricuspid regurgitation, frequency and percentages was used. For quantitative data mean ± S.D was computed. P-value ≤ 0.05 was taken as significant. Results: The mean age of the cases in Group-A was 47.97 ± 8.29 and in Group-B was 51.01 ± 7.78. In our study post-operative RVEDD and TVPG found significant with p-value 0.044 and &lt;0.01 respectively. Similarly, the p-value of follow-up RVSTDI and RVEDD was statistically significant with p-value 0.03 and 0.007 respectively. Conclusion: Both Dacron band and segmental annuloplasty techniques are available for TV repair; however, dacron band placement in TV repair patients is associated with better RV remodelling, and as a result, a more likely improvement in right ventricular function and a better repair outcome are predicted. After tricuspid valve surgery, dacron band implantation is correlated with a lower incidence of TR recurrence and enhanced long-term event-free survival. As a result, this method in tricuspid valve surgery should be used more frequently. Keywords: Segmental Annuloplasty, Dacron Band, TR, TV repair

To Compare Early Outcomes of Warm Verses Cold Blood Cardioplegia in Patients Undergoing Elective Coronary Artery Bypass Graft Surgery (CABG)

Objective: To compare the effects of warm versus cold blood cardioplegia on the myocardium of patients undergoing elective Coronary Artery Bypass Graft (CABG) surgery. Study Design: The study was the Prospective Observational study. Place and Duration of Study: At the Punjab Institute of Cardiology in Bahawalpur, Pakistan, 100 patients with ischemic heart disease was scheduled for open-heart surgery. Methodology: From the 25th of October 2021 to the 25th of October 2022, this prospective observational study was carried out in the Cardiac surgery Department of the PIC in Bahawalpur. One hundred patients participated in this research project overall. The means and standard deviations of the continuous variables were reported, while the frequencies of the categorical variables were given in percentage. SPSS 24 version was utilized for the statistical analysis. The All P values &lt;0.05 were considered statistically significant Results: Our results showed that out of 100 patients the mean age of the cases in Group-A was 57.12±3.9 and in Group-B was 55.45±2.6 with insignificant p-value. The findings of current study showed that the male 41(82.0%) and female 9(18.0%) patients in Group-A while male 38(76.0%) and female 12(24.0%) in Group-B with p-value 0.659. Clinical characteristics i.e. The hypertensive 39(78.0%) in Group A while 35(70.0%) in Group B with significant p-value 0.017. Similarly hyperlipdemia in Group A as 11(22.0%) compared with 15(30.0%) with 0.069. Renal failure patients in Group A was 4(08.0%) while in Group B 3(06.0%) observed with p-value 0.032. The clinical characteristics i.e. (CPB time, cross clamp time, cardioplegia dose, number of grafts and complete revascularization) were statistically significantly as p-value &lt; 0.05. Conclusion: According to the available data, the surgeon can make the call between warm and cold cardioplegia when it comes to patient safety. Keywords: CK-MB, CPB, CABG.

A rare coexistence: Poland’s syndrome and cardiac angiosarcoma

Poland’s syndrome, a rare genetic disorder that accompanies malignancies, musculoskeletal disorders, cardiac and genitourinary syndromes. There is no study that represents the association between cardiac angiosarcoma and Poland’s syndrome. A 24-year-old female patient previously diagnosed with Poland’s syndrome was admitted to our hospital complaining of dyspnea. Diagnostic imaging showed an irregular mass in the right atrial cavity. After successful surgery, she was discharged uneventfully and the 3rd month oncologic follow-up reveals none of residual mass. The coexistence has not been diagnosed and treated in a cardiac surgery department before. With this presentation, we aimed to contribute to the literature with this presentation, for the right and early diagnosis and management of possible new cases in the future can be diagnosed and treated correctly and early.

DIAGNOSTIC ACCURACY OF ALLENS TEST FOR ULNAR COLLATERAL FLOW IN RADIAL ARTERY HARVESTING IN CORONARY ARTERY BYPASS GRATING

To treat coronary artery disease, coronary artery bypass graft (CABG) surgery is done worldwide (CAD). Before harvesting the radial artery for cardiac bypass surgery, Allen's test is frequently used to evaluate the hand's ulnar collateral blood supply. Using Doppler Ultrasonography as a gold standard, this study was created to evaluate the diagnostic precision of Allen's test for the ulnar collateral flow of the donor limb before radial arteryharvesting. This cross-sectional study was conducted from January 2015 to September 2017 at the Jinnah Hospital in Lahore's Cardiac Surgery department. The consecutive sampling/non-probability method was employed. A signed consent form was obtained, and specific demographic data (name, age, and gender) was gathered. SPSS version 21 was used to enter and analyze all of the data. The patients in our study had a mean age of 50.91±9.13 years. The ratio of men to women was 1.3:1. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of Allen’s test was 77.05%, 81.36%, 81.03%, 77.42% &amp; 79.17% taking Doppler test as gold standard. Allen's test, which uses Doppler ultrasonography as the gold standard, is a reliable and valid screening test for the ulnar collateral flow of the donor limb before radial artery harvesting, according to the findings of our study.

Retrograde Autologus Priming and its Effects on Intraoperative Transfusion

Introduction: Extreme haemodilution going on with cardiopulmonary pass imposes an vital chance element recollect for blood transfusion in cardiac surgical patients. Priming of the cardiopulmonary bypass circuit with sufferers' own blood [retrograde autologous priming (RAP)] is a system used to restrict haemodilution and decrease transfusion requirements. Objective: The objective of our study was to evaluate the effects of Retrograde Autologus Priming on reducing intraoperative blood transfusion in cardiac surgery. Methodology: It was cross sectional study, conducted over a period of six month from august 2021- February 2022 at Peshawar Institute of Cardiology, department of cardiac surgery. We enrolled one hundred and sixty patients, n= (160) through prestructured Performa by the use of non-probability convenient sampling method technique. Results: The mean age of the patients (8.77±8.644), mean HB before surgery (13.443±2.9020), after surgery (10.947±2.0891), haematocrit after surgery (34.98±7.697), priming volume (549.32±229.013), effective priming volume (539.69±257.563), extubation time (3.91±1.255) and ICU stay was (2.20±.875). Post-op performance HB level, hematocrit, priming volume, extubation time and ICU stay shows a significant association at p value &lt;0.05. Conclusion: According to the results of our study, it is concluded that reducing CPB priming volume by the RAP techniques reduces homologous blood transfusion in congenital and valvular defect patients. It also shows that RAP technique shows significant association to the postoperative performance of the patients at p-value &lt;0.05.