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Biomedical Research
|
Volume 29
Page 47
allied
academies
CARDIOLOGY AND CARDIOVASCULAR MEDICINE
STEM CELLS AND REGENERATIVE MEDICINE
&
International Conference on
International Conference on
J u n e 1 8 - 1 9 , 2 0 1 8 | O s a k a , J a p a n
Joint Event on
CABG IN DIFFUSE CORONARY ARTERY DISEASE
Shyam K Ashok
Aster CMI Hospital, India
Statement of the problem:
In India 2.78million 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 3mg/Kg given to achieve an ACT >300.Using the octopus as stabilizer, we performan
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 and when 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 18months 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.
shyams2u@yahoo.co.ukBiomed Res 2018, Volume 29 | DOI: 10.4066/biomedicalresearch-C2-006