Shyam Krishnan Ashok
Aster CMI Hospital, India
Scientific Tracks Abstracts: J Cardiovasc Dis Diagn
Statement of the Problem: In India 2.78 million deaths 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 has the 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. Method: We perform OP CAB and use LIMA and veins as conduits to perform the surgery. Once the conduits are harvested, we heparinize with IV Heparin 3 mg/Kg given to achieve an ACT>300. Using the octopus as stabilizer, we perform an endarterectomy 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 20 ml/hr which is continued for 24 hours and the inotropes used are Adrenaline and Dobutamine as and when necessary. Post-operatively Aspirin 75 mg is given and Heparin infusion started after 6 hours 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 endarterectomy offers a good solution to the problem of diffuse coronary artery disease.
Shyam Krishnan Ashok has completed his MBBS and then MS in General Surgery, he did his MCH in CVTS from Seth GS Medical College, Mumbai, India. He later joined Narayana Hrudayalaya, Bangalore, India. He has worked as a Fellow in Adult Cardiothoracic Department in Royal Melbourne Hospital, Australia. His area of interest is coronary artery bypass, especially total arterial revascularization. He is currently working at Aster CMI Hospital as Consultant Cardiothoracic Surgeon.
E-mail: shyams2u@yahoo.co.uk
Cardiovascular Diseases & Diagnosis received 427 citations as per Google Scholar report
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