Considering the prolonged recovery time, less cosmesis, chronic post-sternotomy pain, sternal instability, delayed wound and bone healing, wound infection associated with conventional coronary Artery Bypass Grafting (CABG), minimally invasive surgery has been being tried for decades. Endoscope assisted CABG (Endo-CAB) is a newer development. This reported case is the first one of our series of Endo-CABG, where two grafts were done successfully. Cardiovasc j 2024; 17(1): 48-50
Background: Cardiorespiratory fitness (CRF) is a powerful predictor of outcome in health and diseases, including cardiovascular disease (CVD). CRF shows significant racial variation, and for this, region- and county-specific normative values are needed. The study was done to determine the CRF of healthy Bangladeshi adults. Methods: In this prospective observational study involving 240 men and 70 women, CRF was assessed by symptom-limited exercise tolerance testing (ETT), maximal exercise capacity was determined and expressed in metabolic equivalents (METs), maximal oxygen consumption (V̇O2 max) was calculated and compared with the previously published data. Apparently healthy men and women aged >18 years without significant disease and with negative ETT test results were included. Those with significant illness, including cardiac, respiratory or rheumatological, those on drugs having potential effect on chronotropic or haemodynamic response were excluded. Results: The mean exercise capacity of men and women was 11.56±6.21 and 9.01±1.61 METs, respectively. The METs and estimated V̇O2 max decreased with age in both sexes. Overall, the Bangladeshi men and women had lower maximal exercise capacity than the Western people, almost similar exercise capacity compared to the Koreans, and higher exercise capacity than the Indians. Conclusion: CRF of Bangladeshi healthy subjects should be validated by larger studies and national registry. Future assessment of CRF should be based on cardiopulmonary exercise testing. Cardiovasc j 2024; 17(1): 12-17
Background: Acute kidney injury (AKI) is a common serious complication of cardiac surgery. A low hematocrit during cardiopulmonary bypass is associated with an increased risk of acute kidney injury, mainly due to a low oxygen delivery. Hemodilution is required for effective function of cardiopulmonary bypass during cardiac operations and moderate hemodilution is found to be beneficial for renal protection. But extreme per-operative low hematocrit is linked to adverse renal outcome. The main objective of this study was to determine the utility of per-operative hematocrit level in predicting AKI following cardiopulmonary bypass. Methods: It was a cross sectional study involving fifty patients who underwent cardiac surgery supported by cardiopulmonary bypass. Group A (25 patients) had hematocrit level ≥ 24 % and group B (25 patients) had hematocrit level <24% during cardiopulmonary bypass. Each patient was categorized by Acute Kidney Injury Network (AKIN) criteria based on creatinine changes within the first 48 hours. The independent impact of lower hematocrit on post-operative acute kidney injury was assessed. Results: In this study of the 50 patients, 30% were diagnosed with AKI. Among those 15 patients, 4 were from group A and 11 were from group B (p= 0.031). Most of the patients developed stage 1 AKI according to AKIN criteria (80%). None developed stage 3. Post-operative creatinine was significantly higher in group B than group A. When considering baseline characteristics, we found no difference in age, gender, pre-operative LVEF, diabetes and hypertension. Regarding the intraoperative characteristics, we found no relation with CPB time and cross clamp time (p value 0.982 and 0.596 respectively) with CSA-AKI. Postoperative urine output was not also significantly involved with post-operative AKI. Conclusion: Patients with per-operative hematocrit level above 24% during cardiopulmonary bypass had good postoperative renal function than patients with per-operative hematocrit level below 24%. Cardiovasc j 2024; 17(1): 40-44
Background: Because of concern about the ability to tolerate beating heart grafting, patients with left main coronary artery stenosis (≥50%) have been excluded from off-pump bypass. The objective of the present study was to evaluate the safety and efficacy of off- pump coronary artery surgery in patients with left main coronary artery disease. Methods: From March 2020 to December 2021, a total of 437 patients, 159 of whom had significant LMCA disease, underwent isolated OPCAB surgery under a single Cardiac surgeon at Khulna City Medical College Hospital. We compared the clinical outcomes of 100 patients with LMCA stenosis (LMCA group) with those of 100 propensity score-matched patients without LMCA stenosis (non-LMCA group). We performed off-pump technique in all coronary artery bypass grafting cases. Patients were followed up for any major adverse cardiovascular events up to three years. Results: All CABG were performed by off-pump technique without conversion to on-pump. One patients in the LMCA group (1 of 100; 1%) and one in the non-LMCA group (1 of 100; 1%) died within 30 days after surgery. Follow-up was completed in 98% of the patients. The rates of three-year freedom from all cause death were 97.3% and 77.7% in the LMCA group and non- LMCA group, respectively (p = 0.17), and the corresponding rates for the combined endpoint of myocardial infarction, angina pectoris, repeat coronary intervention, and heart failure were 80.4% and 70.4% (p = 0.98).Conclusions: Off-pump coronary artery bypass grafting is feasible and safe in patients with critical LMCA stenosis and LMCA disease is not recognized as a risk factor after off-pump coronary artery bypass grafting in either the short or the Mid-term. Cardiovasc j 2024; 17(1): 24-30
Background: Great saphenous vein is a popular conduit for coronary artery bypass graft. But the harvest site wound infection increases morbidity and prolong hospital stay. Closing techniques of saphenectony wound may contribute to early post operative outcome of the patient. The purpose of this study was to compare outcomes of the different closing techniques of saphenectomy wound. Methods: This comparative cross-sectional study was carried out with 58 patients who underwent coronary artery bypass graft (CABG) and great saphenous vein was harvested as a conduit. Out of which 29 patients underwent single layer (Group-A) and rest 29 patients underwent double layer closure (Group-B) of saphenectony wound. Incidence of wound complications was compared between the two groups. Results: On analysis of age, sex, weight, comorbidities and per operative variables, no significant differences were observed between two groups. There was significant statistical difference of mean ASEPSIS score (p=0.011) between the group A (4.17±5.9) and group B (9.55±9.44). Serous discharge was noted in 4 (13.8%) patients in group A and 10 (34.5%) patients in group B. Four (13.8%) patients had erythema in group A and 11 (37.9%) in group B. Four (13.8%) patients had purulent exudates in group A and 1 (3.4%) in group B. Three (10.7%) patients had edema in group A and 10 (34.5%) in group B. The differences of erythema and edema were statistically significant (p<0.05) between two groups. Almost three fourth (72.4%) of patients had satisfactory healing in group A and 12 (41.4%) in group B. No patient had severe wound infection. Conclusion: Single layer interrupted closure had shown an overall improved wound outcome and less pain compared to double layer closing technique in terms of erythema, edema and satisfactory wound healing. Cardiovasc j 2024; 17(1): 5-11
