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Short And Mid Term Results Of Concomitant On Pump Beating Heart CABG with Conventional Valve Replacement/repair.

OBJECTIVE:Historically there has been a concern amongst Cardiac surgeons regarding increased morbidity and mortality with increased Cross-clamp time in combined procedures. Therefore we aim to study the short and mid -term results of concomitant empty beating heart CABG with conventional Valve replacement/repair.
METHODS:We analyzed demographics, intra operative profile and clinical data of 72 patients from 2013-2016, who underwent CABG with valve replacement / repair .Mean follow up was 2 years.
RESULTS:Among 72 patients, the 30-day survival was 97.22% (n =70). Preoperatively 38.89% (n=28) patients were in NYHA Class II, 33.34% (n=24) and 27.78% (n=20) in NYHA Class III & IV. 30.56 % (n=22) were smokers and mean LVEF was 46.86%. Patients received an average of 2.23 bypass grafts. Mean CPB and cross clamp time was 148 + 6.2 and 62.7 + 4.8 minutes respectively. The requirement of PPI was in 1.38% (n=1), IABP insertion was done in 22.22 %(n=16). The incidence of stroke and Atrial Fibrillation was in 1.38% (n=1) & 11.12 %(n=8).The post-operative renal failure & pulmonary complication were observed in 4.17 %( n=3) & 5.56 %(n=4). The average hospital & ICU stay was 9.05 days and 3.92 days. There were 2.78 %(n=2) readmission within 3 months, out of which 1 patients underwent stenting of LAD-SVG graft. Mean follow up of 2 years was done in 88.89 % (n=64), where we had 7.81% (n=5) readmissions within 2 years, out of them 1.56% (n=1) required stent to LCx, 1.56% (n=1) required PPI and rest 4.68% (n=3) had heart failure. Follow up Echo revealed improvement in LVEF in 6.25% (n=4) patients, 3.12% (n=2) patients had deterioration LVEF and remaining all maintained their LVEF up to 2 years. Fifty nine patients 92.19% were in NYHA Class I &II. There was 3.12% (n=2) cardiac related late mortality.
CONCLUSION:Concomitant on pump beating heart CABG and Valve replacement appears to reduce cross clamp time and have acceptable short and mid-term outcomes with significant symptomatic improvement and preservation of Left Ventricular function.

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Endorsed by:
The Society of Thoracic Surgeons

Co-sponsored by:
Association of Physician Assistants in Cardiovascular Surgery (APACVS) The International Society for Minimally Invasive Cardiothoracic Surgery Japanese Association for Coronary Artery Surgery
Brazilian Society of Cardiovascular Surgery Fu-Wai Hospital of Beijing Indian Association of Cardiovascular-Thoracic Surgeons
Society for Cardiothoracic Surgery in Great Britain & Ireland