Rapid Recovery After Full Sternotomy Off-Pump Coronary Artery Bypass Grafting in Complex Cases: A Report of 3 Cases.

BACKGROUND While very early discharge at 4 or fewer days after coronary artery bypass grafting (CABG) is proven safe, cost-effective, and not novel, the term "rapid discharge" to indicate discharge at 2 or fewer days has been put forth more recently. However, there have been no such discharges documented in certain complex and challenging clinical scenarios, such as in patients with solitary kidney with deranged renal function, in emergency settings, or in very severe left ventricular dysfunction and dense adhesive pericarditis with diffuse plaque necessitating coronary artery endarterectomy. CASE REPORT I present 3 cases of off-pump coronary artery bypass grafting (OPCAB) performed through conventional full sternotomy that were successfully discharged on the second postoperative day (at 42 h after surgery) in the following clinical settings: (1) patient with solitary kidney with borderline renal function; (2) patient undergoing emergency CABG; and (3) patient with adhesive pericarditis and severe left ventricular dysfunction requiring concomitant coronary endarterectomy with pericardiectomy.

Successful management of penetrating cardiac injury in a limited resource setting without cardiac surgical instruments and heart-lung machine.

Penetrating cardiac injuries (PCI) are often fatal and do not present enough time for effective referrals to higher centers. Most deaths occur in transit from a remote healthcare setting with limited resources. I present the first reported case of PCI in the medical literature to be managed successfully in the absence of heart-lung machine as well as dedicated cardiac surgical instruments and equipment, and which was further complicated by mediastinitis.

2nd postoperative day discharge after full sternotomy off pump coronary artery bypass grafting surgery - A report of 2 consecutive rapid discharges.

Introduction And Importance: Very early discharge after coronary artery bypass grafting (CABG), defined as discharge in ≤4 days after surgery, is considered safe and comes with a host of benefits including lower costs and earlier return to work.

Case Presentation: I present two consecutive cases of off pump coronary artery bypass grafting (OPCAB) performed through conventional full sternotomy that were discharged on the second post-operative day (at 36 and 42 h after surgery), the former being the earliest described in medical literature till date.

Clinical Discussion: From my early experience, I list out all the factors that facilitated such ultra fast-track recovery and present a checklist to enable rapid (<2 days) discharge after CABG.

Analysis of the logistical, economic and minimally invasive cardiac surgical training difficulties in India.

Significant advances have been made in minimally invasive cardiac surgery (MICS) over the past 3 decades. However, the acceptance and practice of MICS continue to remain low in the developing world owing to several challenges. This study aimed to analyse the logistical, economic and training difficulties in MICS with a special focus on the Indian scenario.

Implantable cardioverter defibrillators - the past, present and future.

Since their formal introduction in 1980, implantable cardioverter defibrillators (ICDs) have undergone innumerable design modifications through several generations. They are indispensable today in successfully managing fatal ventricular arrhythmias. Their role in averting sudden cardiac death is recognized beyond doubt.

A Novel Cost-Effective Technique for Speedy Resolution of Infantile Umbilical Hernia: Ammannaya's Technique.

Umbilical hernia in the infant is common and resolves in majority of the cases by 6 years of age. Observation till this age and surgery in the event of persistence are the widely followed management strategies. Trusses, taping, and adhesive strapping have been tried to achieve speedy resolution with variable success and a significant incidence of skin complications.

Lambl's Excrescences: Current Diagnosis and Management.

Lambl's excrescences (LEs) are unusual, yet significant etiology of thromboembolism. LEs are fibrous valvular strands typically occurring at coaptation lines of the left-sided valves. These occur from wear and tear of the valves and comprise of a dense core of collagenous and elastic fibrils enclosed by endothelium.

Effect of octopus tissue stabilizer on cardiac output during off-pump coronary artery bypass graft surgery.

Introduction: Significant hemodynamic derangements can occur during off-pump coronary artery bypass graft (OPCAB) surgery resulting from the displacement of the beating heart, which may necessitate conversion to on-pump surgery.

Aim: We proposed to evaluate the alterations in hemodynamic parameters in patients during the course of anastomosis in OPCAB surgery using the Octopus tissue stabilizer.

Material And Methods: In 100 consecutive patients undergoing OPCAB surgery, hemodynamic variables including cardiac output (CO), heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) were recorded at baseline, during each coronary artery anastomosis at 2 min, 10 min and after release of the Octopus tissue stabilizer.

Fungal endocarditis: what do we know in 2019?

Fungal endocarditis (FE) is an infrequent but a lethal condition. Candida and Aspergillus species are the 2 most commonly implicated pathogenic fungi. Clinical presentation is most often that of a fever of unknown origin, which is hard to differentiate from bacterial endocarditis.

Left sided PAPVC with intact IAS-Surgically managed with vertical vein anastomosis to LA appendage: A rare case report.

Introduction: Partial anomalous pulmonary venous connection (PAPVC) is a rare entity. Only 10% of these are left sided. An intact atrial septum is further uncommon.

Relationship between High Red Cell Distribution Width and Systemic Inflammatory Response Syndrome after Extracorporeal Circulation.

Objective: Cardiac surgical operations involving extracorporeal circulation may develop severe inflammatory response. This severe inflammatory response syndrome (SIRS) is usually associated with poor outcome with no predictive marker. Red cell distribution width (RDW) is a routine hematological marker with a role in inflammation.

Effect of prosthesis patient mismatch in mitral position on pulmonary hypertension.

Objectives: Pulmonary arterial hypertension (PAH) is associated with poor outcome after mitral valve replacement (MVR). We proposed to evaluate the effect of valve prosthesis patient mismatch (PPM) on pulmonary arterial (PA) pressure following MVR.

Methods: Five hundred patients who have undergone MVR were studied retrospectively.

A Concomitant Intramyocardial and Pulmonary Hydatid Cyst: A Rare Case Report.

Cardiac hydatid cyst is an uncommon but potentially fatal disease. In cystic Echinococcus humans are an accidental host. Liver and lungs are the most frequently involved organs.