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Journal of Public Health Policy and Planning | Volume 3
April 08-09, 2019 | Zurich, Switzerland
Health Care and Neuroscience
International Conference on
CABG in diffuse coronary artery disease
Shyam K Ashok
KIMS Hospital, India
Statement of the problem:
In India 2.78 million
death are due to Cardiovascular diseases of which
50 % are due to CAD. Peculiarities of CAD patterns
in Indian patients- Younger age at presentation, high
incidence of DVD and TVD, diffuse involvement,
distal disease and significant LV dysfunction at
presentation
Diffuse CAD:
Length of significant stenosis > 20 mm,
multiple significant stenosis (> 70% narrowing) in
the same artery separated by segment of apparently
normal vessel and significant narrowing involving
the whole length of coronary artery.
Methodology:
We in our institute, perform OP CAB
and use LIMA and veins as conduits to perform
the surgery. Once the conduits are harvested,
we heparinize with I.V. Heparin 3 mg/Kg given to
achieve an ACT >300. Using the octopus as stabilizer,
we perform an endartrectomy of the LAD first and
then use a vein patch to cover the defect. LIMA
is then used to anastomose the LAD on the vein
patch. Veins are used to bypass the LCX and RCA,
as deemed appropriate. The proximal ends of the
vein grafts are anastomosed to Ascending Aorta
with side clamp and heart beating. Intra op we start
Lomodex infusion 20ml/hr which is continued for 24
hours and the inotropes used are Adrenaline and
Dobutamine as andwhen necessary. Postoperatively
aspirin 75mg is given and Heparin infusion started
after 6hours to maintain ACT of around 150 for
24 hours. Patients are usually extubated after 4
hours provided they are hemodynamically stable.
Anticoagulation by Acitrom is commenced orally
from day 1 to maintain an INR of 2 for 3 months.
Result:
Out of the 20 patients in last 18 months
outcomes have been excellent with no in-hospital
mortality or cerebrovascular incidents.
Conclusion:
Off pump CABG with coronary end-
arterectomy offers a good solution to the problem
of diffuse coronary artery disease.
Speaker Biography
ShyamK Ashok is a Consultant in Cardiac Surgery, After completing his MBBS
and MS in General Surgery, he did his Mch in CVTS from Seth GS Medical
College, Mumbai in 2008. He later joined Narayana Hrudayalaya, Bangalore
in 2008, which a 1000 bedded hospital executing close to 600 open heart
surgeries in a month. He worked as a Fellow in Adult Cardiothoracic
department in Royal Melbourne Hospital, Australia, which is the second
largestCardiothoracicunit inthewholeofAustralia.Afterworking inAustralia
for 2 years he rejoined Narayana Hrudayalaya, as Consultant Cardiothoracic
Surgeon in 2012 and worked there till 2015. He has independently
performed about 1000 open heart surgeries, consisting of Coronary Artery
bypass surgeries and Valve Replacements. His area of interest is Coronary
Artery bypass, especially Total Arterial Revascularization. He joined Aster
CMI Hospital in Feb 2016 as Consultant Cardiothoracic Surgeon.
e:
shyams2u@yahoo.co.uk