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V M Kohli

Publications and source records attributed to V M Kohli.

6 recordsLinked to original sources
PubMed1997

Significantly reduced incidence of stroke during coronary artery bypass grafting using transesophageal echocardiography.

OBJECTIVE: Protruding atheromas of thoracic aorta have been identified as a source of systemic emboli and a major cause of stroke following cardiac surgery. This prospective study used transesophageal echocardiography (TEE) to identify atherosclerosis of thoracic aorta intraoperatively. The influence of risk factors was studied. Finally the impact of modifying surgical technique on the outcome was evaluated. METHODS: Seven-hundred and ninety-two patients undergoing coronary artery bypass grafting (CABG) were evaluated with TEE. Depending on the location and extent of thoracic aortic disease various surgical modifications were carried out, e.g. hypothermic circulatory arrest with aortic arch atherectomy, CABG on beating heart and others. The stroke rate in this group of patients was determined and analysed. RESULTS: Of the 114 patients with grade II and III atheromas of aortic arch and ascending aorta in whom surgical modifications were done, none had stroke. The overall stroke rate in the study group was 0.76%, six patients had stroke. Stepwise logistic regression identified age, diabetes, serum triglycerides and VLDL as important risk factors. Associated carotid artery disease and calcium on chest X-ray (CXR) were identified as important predictors of disease. CONCLUSIONS: Intraoperative TEE is an invaluable modality for evaluating the thoracic aorta. There is significant reduction in stroke rate following identification of atheromas and modification of surgical technique.

Adult↗
PubMed1997

Cardioprotective effects of diltiazem infusion in the perioperative period.

OBJECTIVE: To evaluate the perioperative effects of intravenous diltiazem infusion on left ventricular functions, hemodynamics and as an anti-ischemic and antiarrhythmic agent in patients undergoing coronary artery bypass grafting (CABG). METHODS: A double blind, randomised study was performed on 71 patients undergoing elective CABG. Infusion of diltiazem (0.1 mg/kg per h, n = 34) or nitroglycerin (1 microgram/kg per min, n = 37) was given for 24 h starting from onset of cardiopulmonary bypass. Holter monitoring, electrocardiogram and serum cardiac enzymes levels were used to diagnose myocardial ischemia. Myocardial function was assessed by perioperative transesophageal echocardiography. RESULTS: The two groups did not differ with respect to preoperative and operative data. Diltiazem had no influence on hemodynamic parameters except for significant reduction in post operative heart rate and pulse pressure rate. Transient ischemic events (dilitiazem 10.2% versus nitroglycerin 33.3%, P = 0.15) and transient coronary spasm (diltiazem-6.8% versus nitroglycerin 25.9%, P = 0.15) were reduced in the diltiazem group as compared with the nitroglycerin group. The postoperative incidence of atrial fibrillation (diltiazem 3% versus nitroglycerin 22%, P = 0.03), supra ventricular tachycardia (diltiazem-3% versus nitroglycerin-22%, P = 0.03) and average ventricular premature contraction per h (diltiazem-40.2 +/- 10.2 versus nitroglycerin 53.8 +/- 12.3, P < 0.01) were significantly lower in the diltiazem group. Transesophageal echocardiography showed no significant difference in left ventricular functions and better preservation of left ventricular diastolic functions in post cardiopulmonary bypass period in diltiazem group. In addition mean deceleration time for the E wave on a 12 h post cardiopulmonary bypass period was significantly lower in the diltiazem group as compared with nitroglycerin (diltiazem 131 +/- 6 versus nitroglycerin 171 +/- 6, P < 0.01). CONCLUSION: The present study demonstrates that diltiazem infusion provides superior anti-ischemic protection and control of supraventricular arrhythmias as compared to nitroglycerin and does not produce any negative inotropic effect, as demonstrated by transesophageal echocardiography.

Aged↗
PubMedDate not supplied

Transmyocardial laser revascularisation as an adjunct to CABG.

Transmyocardial laser revascularisation (TMLR), a new technique in which the ischaemic myocardium is perfused via laser-created transmural channels, was performed in 116 patients at the Escorts Heart Institute. TMLR was combined with CABG in 104 of these patients. The main indication for the combined procedure was the presence of one or more bypassable vessels along with diffuse disease in the other vessels. The age of the patients ranged from 37 to 73 years. Preoperatively, 53.84 percent of patients had Canadian Cardiovascular Society (CCS) class III angina while 24 percent had class IV angina. The mean LVEF was 46 percent; however, 19 percent of the patients had LVEF < 35 percent. Thirteen patients were operated upon a beating heart without cardiopulmonary bypass. The early mortality was 2.88 percent, 7.69 percent of patients showed elevation in CPK-MB, while 5.76 percent had a rise in Troponin 'T' and 2 percent of patients showed ECG changes. The mean follow-up was 7.6 months. Myocardial perfusion scan showed a step-wise improvement in reversible ischaemia, the perfusion index increasing from 52 percent at 3 months to 91 percent at 12 months. At 12 months, 91.6 percent of patients were angina-free. The Karnofsky score of 46 percent at baseline also increased to 86 percent at 12 months.

Adult↗
PubMedDate not supplied

Coronary artery bypass surgery without cardiopulmonary bypass: short- and mid-term results.

From March 1994 to April 1997, 433 patients had undergone coronary artery bypass grafting without cardiopulmonary bypass in our institute. Sixty-eight patients had various organ dysfunctions and/or aortic atheroma or calcification and were regarded as high risk for cardiopulmonary bypass. In 277 patients surgery was performed through midline sternotomy, while in 156 minithoracotomy approach was used. In 361 patients single coronary artery bypass grafting was done, and in 72 two-coronary arteries were bypassed. In 63 patients who had graftable vessels in anterior wall and diffusely diseased ungraftable vessels in posterolateral and/or inferior wall, transmyocardial laser revascularisation was also done along with coronary artery bypass grafting to achieve complete myocardial revascularisation. Nine patients in this series were also subjected to simultaneous carotid endarterectomy along with myocardial revascularisation. In two patients complementary percutaneous transluminal coronary angioplasty of left circumflex coronary artery was done five days after minithoracotomy and left internal mammary artery to left anterior descending coronary artery bypass grafting. Forty-two cases were extubated in operating room. Average blood loss was 260 ml. Six patients were reexplored for postoperative bleeding. Seven patients had perioperative myocardial infarction. One developed neurological complication. Hospital mortality was 2.3 percent (10/433 cases) and four deaths were due to malignant ventricular arrhythmias. Nine patients developed chest wound complications. Average hospital stay after operation was six days, 423 patients were discharged from hospital and all of them were asymptomatic. During three years follow-up (range 3 to 38 months) there were three known cardiac deaths. Ninety percent (391) patients reported to the follow-up clinic and 91 percent of them were angina-free. In patients who were subjected to transmyocardial laser revascularisation along with coronary artery bypass grafting, myocardial perfusion scan showed a step-wise improvement in reversible ischemia. The perfusion index increased from 52 percent at three months to 90 percent at 12 months. We conclude that coronary artery bypass grafting without cardiopulmonary bypass can be done with relatively low mortality, more so in a group of patients in whom cardiopulmonary bypass poses a high risk. Transmyocardial laser revascularisation is a suitable means to provide complete myocardial revascularisation along with coronary artery bypass surgery in patients who have graftable vessels in anterior wall and ungraftable vessels in posterolateral and inferior walls.

Adult↗