Efficacy of Whole-Blood Del Nido Cardioplegia Compared with Diluted Del Nido Cardioplegia in Coronary Artery Bypass Grafting: A Retrospective Monocentric Analysis of Pakistan.

Background and Objectives: Cardioplegia is one of the most significant components used to protect the myocardium during cardiac surgery. There is a paucity of evidence regarding the utilization of whole-blood Del Nido cardioplegia (WB-DNC) on clinical outcomes in coronary artery bypass grafting (CABG). The purpose of this retrospective cross-sectional study is to compare the effectiveness of diluted (blood to crystalloid; 1:4) Del Nido cardioplegia (DNC) with WB-DNC in patients who underwent elective CABG in a tertiary care hospital in Lahore-Pakistan. Materials and Methods: This was a retrospective descriptive study conducted at the Department of Cardiovascular Surgery, King Edward Medical University, Lahore. The medical database of all consecutive patients admitted from January 2018 to March 2020 and who fulfilled the inclusion criteria were reviewed. Results: Out of 471 patients admitted during the study period, 450 underwent various elective cardiac surgeries. Out of 450, 321 patients (71.33%) were operated on for CABG. Only 234/321 (72.89%) CABG patients fulfilled our inclusion criteria; 120 (51.28%) patients received WB-DNC, while 114 (48.71%) patients were administered with DNC. The former group presented with better clinical outcomes compared with the latter in terms of lesser requirements of inotropic support, low degree of hemodilution, shorter in-hospital stay, improved renal function, and cost-effectiveness. Peak values of serum Troponin-T (Trop-T), creatine kinase-myocardial band (CK-MB) release, and activated clotting time (ACT) were also lower in the WB-DNC group compared with the DNC group. Conclusions: The WB-DNC conferred better myocardial protection, improved early clinical outcomes, and also proved to be economical for patients undergoing elective CABG compared with classical crystalloid cardioplegia solution.

Neurological outcome after coronary artery bypass surgery.

BACKGROUND: Neurological dysfunction is a common complication after cardiac surgery. Despite significant advances in cardiopulmonary bypass (CPB) technology, surgical techniques and anaesthetic management, central nervous system complications occur in a large number of patients undergoing surgery requiring CPB. The objective of this study was to determine neurocognitive status of the patients undergoing coronary artery bypass grafting (CABG) and to find any causative or associated factor. METHODS: We evaluated 1000 consecutive patients undergoing primary isolated coronary artery bypass grafting (CABG) at a tertiary care cardiac institute from July 2000 to December 2001 to determine the neurological outcome after CABG and risk factors involved. The demographic and perioperative data were analyzed by Chi2 analysis. RESULTS: A history of diabetes, hypertension, increased age, preoperative neurological event, aortic atheromatous / calcific disease, bilateral carotid artery disease, intermittent aortic cross clamping and evidence of mural thrombi are all co-related with increased risk of neurological damage after CABG. When analyzed in a stepwise logistic regression model, diabetes mellitus, aortic disease increased age and mural thrombi carried a higher probability that the patient would have a postoperative neurological deficit. CONCLUSIONS: We conclude that although these factors are individually involved in the adverse neurological outcome after CABG but the combination of these factors greatly increases the risk of postoperative neurological consequences and only few of them are avoidable.

Acute renal failure after cardiopulmonary bypass surgery.

BACKGROUND: Acute renal failure (urine output <0.5 ml/kg/hr.) following cardiopulmonary bypass is an uncommon but highly lethal complication which arises in the setting of inadequate cardiac function and may be associated with multi-organ failure. Acute renal failure (ARF) after cardiopulmonary bypass occurs in about 8% of adult cardiac surgical patients with some preoperative renal impairment and in about 3-4%, of patients with normal preoperative renal parameters. This study was conducted to determine the frequency of acute renal failure after cardiopulmonary bypass operations and to find possible risks factors. METHODS: We analyzed the data of 500 consecutive patients who survived the first 24 hours after open heart surgery at Punjab Institute of Cardiology, Lahore as this is the minimum time to evaluate post-operative renal function, their morbidity, mortality and the main contributing risk factors, from July 2000 to Dec. 2000. The association between preoperative, intra-operative and postoperative variables and the development of ARF was assessed by multivariate logistic regression. RESULTS: Of the 500 consecutive patients 35 (7%) patients developed acute renal failure (serum creatinine>2.5 mg/dl) and 102 (20.4%) patients developed acute renal dysfunction (serum creatinine 1.6-2.4 mg/dl). Positive risk factors noted in the development of ARF were age, raised preoperative blood urea and creatinine, diabetes mellitus, low cardiac output state, oligurea, total CPB time, total cross clamp time and significant hypotension during the procedure or during intensive care unit (ICU) stay. Mortality rate for established ARF was extremely poor (88.8%) and there were only four (4) survivors among those requiring dialysis. CONCLUSIONS: Prevention of this disastrous complication appears to be better than treatment once it is fully established. However newer aggressive forms of early renal replacement/transplant therapies may have some promise.