Brij Bihari Kushwaha

Comparison of left internal mammary harvesting techniques for coronary artery bypass grafting: A prospective study

Introduction: Left internal mammary artery (LIMA) is the most common arterial conduit used for patients undergoing coronary artery bypass grafting (CABG) surgery. Maintaining pleural integrity during harvesting has been documented to have better patient outcomes. Hence, we evaluated postoperative outcomes using two different LIMA harvesting techniques, one with intact pleura and other with pleura opened. Methods: In this prospective study, we recruited a total of 110 patients undergoing CABG. Based on the pleural being intact or opened, the patients were divided in two groups. In Group 1, LIMA was harvested with pleura intact (extra-pleural approach) while in Group 2, LIMA was harvested with pleura being opened (intrapleural / pleurotomy). The primary objective was to evaluate the impact on various post-operative parameters like total ventilatory time, mediastinal drainage, need for Blood transfusions, post operative deterioration of lung function , post operative pain scores and duration hospital stay. Results: Out of 110 patients undergoing CABG, LIMA was harvested by extra-pleural approach in sixty-six while in the rest forty-four pleurotomy was needed. The baseline demographic attributes of patients were similar in both groups. The post operative parameters such as ventilatory time, blood loss, need for blood transfusions, and prolonged hospital stay were found to be significantly higher in the group with intrapleural LIMA harvest technique (P <0.05). Pulmonary complications like pleural effusion, atelectasis were more frequent with in the intrapleural harvest as compared to extra-pleural harvest technique.(P <0.001). Post operative pain scores as evaluated by NRS scale were also significantly higher after intrapleural harvest (P <0.001). Conclusions: Harvesting of LIMA for CABG extrapleurally has significant post-operative benefits and faster recovery compared to pleurotomy and intraplueral approach.

Morbidity and mortality after autotransfusion following open heart surgery

BackgroundThe technique of ‘blood pooling’ before the onset of cardiopulmonary bypass (CPB) has been shown to be beneficial as a single technique in patients having elective open heart surgery. We sought to more clearly evaluate the role of intra-operative autologous donation also known as acute normovolemic haemodilution in open heart surgery.MethodsThe study was conducted in the Department of Cardiothoracic and Vascular Surgery, King George’s Medical University, Lucknow, India, in patients who underwent open heart surgery under cardiopulmonary bypass. Autologous blood transfusion was used in all the patients who underwent surgery on CPB since August 2009. Patients were divided into two groups: group I (study group)—patients operated between August 2009 and December 2011 and who received autologous blood and group II (control)—those operated before August 2009 and who did not receive autologous blood transfusion.ResultsThe post-operative haemoglobin and coagulation profile measured on the first post-operative day differed significantly between the two groups. Intensive care unit (ICU) stay, hospital stay, inotropic support and ventilatory support were significantly less in group 1. Mediastinal drainage was found to be significantly higher in the control group compared to the study group. The mean volume of packed red blood cell, fresh frozen plasma and platelet units transfused per patient in the study group were significantly less than the control group.ConclusionThe use of intra-operative autologous blood donation and transfusion improves haemostasis, decreases the post-operative blood loss and improves the post-operative outcome in terms of intensive care unit stay, hospital stay, morbidity and mortality.