Coronary-Coronary bypass graft as a safe and an alternative technique for revascularization of coronary arteries

Coronary–coronary bypass graft was first performed by Rowland and Grooters. This technique can be performed between two segments of the same coronary artery using saphenous vein grafts or free arterial grafts in on/off-pump coronary artery bypass grafting, also can be an alternative safe technique in some cases as calcified ascending aorta, porcelain aorta and insufficient graft length. The coronarycoronary bypass graft can provide nearly the same flow rate as conventional coronary artery bypass graft, another advantage this technique is that we can use to decrease sternal and respiratory morbidity. we performed this technique to a 55-year-old woman to whom coronary angiography showed critical three-vessel disease, using a free segment of right internal mammary artery, combined to conventional coronary artery bypass graft. The postoperative course was uneventful with the absence of ischemic lesions and the grafts were patent at 6 months after procedure.

Early Outcome of Conventional Coronary Artery Bypass Grafting with Peri-operative Hyperglycaemia in Diabetic and Non- Diabetic Patients in NICVD, Dhaka

Background: Peri-operative hyper glycaemia has been defined as the average of blood glucose test obtained by venous or arterial sampling on the day of and the day after surgery. Here the association between peri-operative hyper glycaemia and outcomes among patients undergoing coronary artery bypass grafting was measured. Objectives: Evaluation of early outcome of conventional coronary artery bypass grafting with perioperative hyperglycemia in diabetic and non-diabetic patients & to compare the outcomes in both the groups. Methodology: The study was a prospective observational analytic study conducted in National Institute of Cardiovascular Diseases, Dhaka from January 2010 to December 2011 in 60 patients having ischaemic heart disease with or without diabetes mellitus. Result: Postoperative ventilation time and ICU stay both were significantly longer in the diabetic group as compared to their non-diabetic counterparts (p<0.001). Pneumonia and all other infections and complications were also more in the former group. None in either group died. The diabetic group stayed on an average 4 days more than the non-diabetic group (p<0.001). Conclusion: The study concluded that outcome of coronary revascularization in non-diabetic patients with peri-operative hyper glycaemia is better than that in diabetic patients with peri operative hyper glycaemia. J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 39-42

One-year cost-effectiveness and safety of simultaneous hybrid coronary revascularization versus conventional coronary artery bypass grafting

OBJECTIVES To evaluate the cost-effectiveness and safety of simultaneous hybrid coronary revascularization (sHCR) compared to conventional coronary artery bypass grafting (CABG) in elective patients with multivessel coronary artery disease. METHODS Cost–utility analysis of a prospective cohort follow-up study comparing per protocol 50 sHCR patients to 50 contemporaneous matched patients undergoing CABG. Resource utilization data and health-related quality of life were collected prospectively, and the cumulative 1-year costs were assessed from the Danish health sector perspective. Effectiveness was measured by quality-adjusted life years using EuroQol-5D. Probabilistic sensitivity analyses using bootstrapping were conducted. Secondary safety measures including early clinical outcomes and freedom from major adverse cardiac or cerebrovascular events at 1 year were assessed. RESULTS The clinical trial was discontinued prematurely due to safety reasons after inclusion of 50 patients (24 sHCR; 26 CABG), as the chest tube output and the risk of postoperative pleural effusions requiring thoracocentesis were significantly increased following sHCR compared with CABG. Based on 48 patients available for 1-year follow-up, both treatment strategies were similarly effective (quality-adjusted life year difference between the groups −0.019), with a net cost difference in favour of conventional CABG estimated to be €2173 per patient. Exclusion of 1 outlier patient with chronic renal failure and deep sternal wound infection in the sHCR group resulted in an equalization of the total 1-year costs. CONCLUSIONS At 1 year, sHCR was less cost-effective than conventional CABG and associated with higher chest tube output and a higher risk of postoperative pleural effusions requiring thoracocentesis. Clinical trial registration NCT01496664.

Effects of Preoperative Mean Platelet Volume on Early Outcomes of Patients After Conventional Coronary Artery Bypass Graft Surgery

An elevated mean platelet volume is associated with increased platelet activation and thus may predict thrombotic events including major cardiac adverse events after CABG surgery. The association of mean platelet volume with in-hospital outcome of patients after coronary artery bypasses grafting surgery was investigated in this study. Preoperative mean platelet volume was obtained prospectively in 8^ consecutive patients undergoing conventional coronary artery bypass surgery. Postoperative mortality and major adverse events were recorded in the early postoperative Period. Combined adverse events including post operative Myocardial Infarction (Ml), arrhythmia, bleeding and death occurred in 27 patients (33.3%) during the early follow-up. The preoperative mean platelet volume levels were found to be associated with postoperative adverse events (p<0.05). In multivariate logistic regression models, the preoperative mean platelet voluue levels was found strong independent predictor of combined adverse events after surgery (OR 1.968, p=0.008).University Heart Journal Vol. 14, No. 1, Jan 2018; 24-27