الفهرس 
Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
his prospective observational study was conducted in National Heart Institute of Egypt. One hundred patients with multi-vessel CAD indicated for CABG were included in the study, and divided into two groups:
group I: patients with no history of previous PCI.
group II: patients with history of PCI before CABG
All patients are diabetic.
Patients with single vessel disease, combined CABG with other cardiac procedures, emergency CABG patients, and significant stenosis of carotid arteries with CABG were excluded from the study.
Preoperative coronary angiography (CA) was used to assess the number and location of diseased vessels in both groups. All patients underwent conventional general anaesthesia, standard median sternotomy, standard cardiopulmonary bypass and antegrade warm blood cardioplegia.
There was a statistical difference in age between the two groups, but the P value was not significant for gender distribution. No statistical differences were found for any of the risk factors.
There was no statistical difference in all New York Heart Association (NYHA) classes of dyspnoea between the two groups. There was no statistical difference in preoperative comorbidities between the two groups, but previous myocardial infarction (MI) was more common in group II.
Echocardiography showed no difference in mean end-systolic diameter (ESD), resting segmental wall motion abnormalities (RSWMA) or ejection fraction (EF) between the two groups, but mean end-diastolic diameter (EDD) was higher in group II.
The SYNTAX score was calculated preoperatively for groups I and II. The mean preoperative SYNTAX score for group II was 18.77, which was not significant compared to group I which was 20.69.
The mean aortic cross-clamp (ACC) time was 69.49±24.73 minutes for group I and 61.81±28.40 minutes for group II, while the cardiopulmonary bypass (CPB) time was 102.07±29.79 minutes for group I and 91.47±41.49 minutes for group II, with no statistical significance between the two groups in either case.
Inotropes were used more often in group II than in group I, but this was not the case for intra-aortic balloon pump (IABP), mean ventilation time (10.22±12.08 hours vs. 12.31±10.28 hours), intensive care unit (ICU) stay (3.30±4.51 days vs. 2.89±1.44 days), but hospital stay was longer in group II (9.3±3.8 days vs. 11.23±3.80 days).
When analysing individual morbidities, re-operation for bleeding (5 vs 13 patients), superficial wound infection (9 vs 19 patients) and deep wound infection (1 vs 6 patients) were statistically higher in group II. Overall morbidity was significantly higher in group II, with 20 patients in group I and 33 patients in group II. There was no difference in in-hospital mortality between the two groups (4 vs 3 patients).
One month postoperative echo was performed and showed no statistical difference between the two groups in mean ESD (3.46±0.75 vs. 3.5±0.76 centimetres (cm)) and mean EDD (4.45±0.98 vs. 5.09±0.66 cm), but there was a difference in postoperative EF (60.2±6.28 vs. 58±8, and postoperative RSWMA where group I was better.