Predictors of clinical outcome after mitral valve replacement

Background: To identify and study predictors of morbidity, mortality, and survival after mitral valve replacement. Methods: We have examined 186 patients undergoing isolated mitral valve surgery between January 2013 to January 2015, with respect to preoperative clinical features, echocardiographic findings, hemodynamics and surgical approaches. Coronary angiography was done as a routine in all patients above 40 yrs of age & coronary artery bypass grafting with mitral valve replacement was done in 7 patients. The operative mortality was 5.37%. Postoperatively patients were followed up at 3 months interval for first 1 year & at 6 months interval thereafter. Results: Multivariate statistical analysis demonstrated that patients age > 60 years, patients with symptoms NYHA Class–IV, ventricular arrhythmias, associated disease (Coronary artery disease, Infective endocarditis), end diastolic diameter measuring ≥60 ± 10mm, left atrial Dimension ≥ 65 mm, chordal preservation (Partial / Total) independently influenced the morbidity and Mortality. Conclusion: Strategies to diminish operative mortality should include careful assessment of the risks factors in elderly patients, early operative intervention before deterioration that necessitates urgent surgery, and use of improved techniques of myocardial protection in high-risk patients

Role of minimally invasive surgery in cardiac valve disease

Introduction: Over the past decade minimally invasive cardiac surgery has gained significant popularity, more cases of valve, bypass and congenital surgery are being done by smaller incisions as experience increases. Materials & Methods: Between January 2013 and December 2015 a total of 50 cases were performed using ministernotomy or right thoracotomy. The patients were between 17-58 years of age and included 29 males, 21 females. Results: In Minimally invasive surgery average pump time was 20-60 minutes, cross clamp time 30-50 minutes, ventilation <8 hours, ICU stay < 1day, 2 or less units of blood required in majority of patients. Conclusion: Minimally invasive cardiac surgery results in smaller incisions, shorter ventilator time, ICU and hospital stay, faster recovery, less pain, lower incidence of infection and bleeding and better cosmesis

Role of thymectomy in myasthenia gravis

Aims and Objective: The aim of study is to show the effect of thymectomy with symptomatic improvement in patients and decrease in dose of medication requirement. To study the outcome of patients with respect to histology, duration of symptoms, remission of symptoms and post operative outcome. Methods: We prospectively analysed 28 patients with symptoms of myasthenia gravis with respect to patients profile, patients remission of symptoms with respect to age, and grade of disease, the response to thymectomy with respect to histology, and duration of symptoms. Result and Conclusion: Patients mainly present with easy fatigability, patients with mild disease respond well to surgery, hyperplasia is favorable histology for remission and lesser the duration of symptoms more are the chances of remission of disease