Prospective Randomized comparison of Off-pump and On-pump Multivessel coronary artery bypasses surgery

Aim: To ascertain the non-inferiority of off-pump CABG when compared to on-pump CABG in terms of angiographically assessed graft patency at 3 months. Material & Methods: This Prospective Randomized comparison of Off-pump and On-pump Multivessel coronary artery bypass surgery To Evaluate outcomes and graft patency (PROMOTE patency) trial was conducted in Indira Gandhi Institute of medical Sciences, Patna, Bihar, India over a period of one year. Results: A total of 300 patients were enrolled and were randomly assigned to either off-pump CABG (n = 150 patients) or on pump CABG (n = 150 patients). Of 300 patients, 280 patients at 1 month and 295 patients at 3 months survived and were analyzed for MACCE. The incidence of asymptomatic carotid artery stenosis was 0.66% (1 patient) in off-pump and 0.66% (1 patient) in on-pump group, p = 1.01 in our study. No difference was observed between the groups in terms of index of completeness of revascularization (number of grafts performed divided by number of grafts intended) 0.90 vs. 1.00 (p=0.7).&nbsp

A retrospective assessment of the early and medium outcomes of on-pump beating-heart versus off-pump CABG in patients with moderate left ventricular dysfunction (LVEF)

Aim: To compare the early and medium outcomes of on-pump beating-heart (OPBH) coronary artery bypass grafting (CABG) and off-pump CABG (OPCABG) in patients with left ventricular ejection fraction (LVEF) between 30% and 40%. Material & Methods: This study was conducted as a retrospective observation over a period of 1 year at the Department of Cardiothoracic and Vascular Surgery, Indira Gandhi Institute of medical Sciences, Patna, Bihar, India.130 patients were selected for this study. All patients were divided into 2 groups, according to the revascularization method: OPCABG group and OPBH group. Results: LVEF before discharge significantly improved from 34.39 ± 4.21 to 44.27 ± 7.29 in the OPBH group and from 34.27±4.61 to 42.66 ± 8.20in the OPCABG group (P<0.001). All survival patients have been echocardiographically examined after 6 months which showed a significant higher early postoperative LVEF in the OPBH group than in the OPCABG group (45.28 ± 6.10 versus 44.42 ± 7.08%, respectively; P=0.002). Conclusion: The OPBH technique was a safe and an acceptable alternative for surgical revascularization in patients with moderate left ventricular dysfunction which provided better midterm MACE-free survival compared with OPCABG

A Retrospective Assessment of the Early and Medium Outcomes of On-pump Beating-heart Versus Off-pump CABG in Patients with Moderate Left Ventricular Dysfunction (LVEF)

Aim: To compare the early and medium outcomes of on-pump beating-heart (OPBH) coronary artery bypass grafting (CABG) and off-pump CABG (OPCABG) in patients with left ventricular ejection fraction (LVEF) between 30% and 40%. Material & Methods: This study was conducted as a retrospective observation over a period of 1 year at the Department of Cardiothoracic and Vascular Surgery, Indira Gandhi Institute of medical Sciences, Patna, Bihar, India.130 patients were selected for this study. All patients were divided into 2 groups, according to the revascularization method: OPCABG group and OPBH group. Results: LVEF before discharge significantly improved from 34.39 ± 4.21 to 44.27 ± 7.29 in the OPBH group and from 34.27±4.61 to 42.66 ± 8.20in the OPCABG group (P<0.001). All survival patients have been echocardiographically examined after 6 months which showed a significant higher early postoperative LVEF in the OPBH group than in the OPCABG group (45.28 ± 6.10 versus 44.42 ± 7.08%, respectively; P=0.002). Conclusion: The OPBH technique was a safe and an acceptable alternative for surgical revascularization in patients with moderate left ventricular dysfunction which provided better midterm MACE-free survival compared with OPCABG

Short-term prognostic value of perioperative coronary sinus-derived-serum cardiac troponin-I, creatine kinase-MB, lactate, pyruvate, and lactate-pyruvate ratio in adult patients undergoing open heart surgery

Objectives: To investigate the release pattern of different cardiac metabolites and biomarkers directly from the coronary sinus (CS) and to establish the diagnostic discrimination limits of each marker protein and metabolites to evaluate perioperative myocardial injury in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB). Patients and Methods: Sixty-eight patients undergoing first mitral and/or aortic valve replacements with/without coronary artery bypass grafting and Bentall procedure under CPB and blood cardioplegic arrest were studied. All cardiac metabolites and biomarkers were measured in serial CS-derived blood samples at pre-CPB, immediate post aortic declamping, 10 minutes post-CPB and 12 hrs post-CPB. Results: Receiver operating characteristic curve analysis of cardiac biomarkers indicated lactate-pyruvate ratio as the superior diagnostic discriminator of myocardial injury with an optimal "cut-off" value >10.8 immediately after aortic declamping (AUC, 0.92; 95% CI: 0.85-0.98). Lactate was the second best diagnostic discriminator of myocardial injury with an optimal "cut-off" value >2mmol/l at immediately after aortic declamping (AUC, 0.89; 95% CI: 0.80-0.96). Cardiac troponin-I was the third best diagnostic discriminator of myocardial injury with an optimal "cut-off" value >2.1ng/ml at immediately after aortic declamping (AUC, 0.88; 95% CI: 0.80-0.95). Creatine kinase-MB was the fourth best diagnostic discriminator of myocardial injury with an optimal "cut-off" value >58 log units/ml prior to decanulation (AUC, 0.85; 95% CI: 0.78-0.94). Conclusions: Measurable cardiac damage exists in all patients undergoing cardiac surgery under cardioplegic arrest. The degree of myocardial injury is more in patients with poor ventricular function and those requiring longer aortic clamp time. CS-derived lactate-pyruvate ratio, lactate, cTn-I served as superior diagnostic discriminators of peri-operative myocardial damage