Off-Pump Coronary Artery Bypass Grafting in Patients with Left Ventricular Dysfunction: Short-Term Results from a Single Center in Bangladesh

Background: Off-pump coronary artery bypass grafting (OPCAB) is considered a safer alternative to on-pump surgery, especially in patients with left ventricular dysfunction (LVD). Objectives: This study assessed short-term outcomes and functional improvements in LVD patients post-OPCAB. Methods: The study included 200 coronary artery disease patients who underwent isolated off-pump coronary artery bypass grafting (OPCAB) at the National Heart Foundation Hospital and Research Institute between January 2019 and June 2020. Patients were categorized into Group 1, with a left ventricular ejection fraction (LVEF) of 30% - 39%, and Group 2, with an LVEF of 40% or higher. Echocardiographic assessments of left ventricular dimensions and ejection fraction were performed preoperatively, at discharge, and one month postoperatively. Results: In Group 1, preoperative left ventricular internal dimensions during diastole (LVIDd) and systole (LVIDs) were 53.48 ± 4.40 mm and 44.23 ± 3.93 mm, respectively, with a left ventricular ejection fraction (LVEF) of 35.28% ± 2.26%. At discharge, these values improved to 51.58 ± 4.04 mm (LVIDd), 41.23 ± 5.30 mm (LVIDs), and 39.25% ± 3.75% (LVEF). One month postoperatively, further improvements were observed: 46.29 ± 3.76 mm (LVIDd), 37.45 ± 3.68 mm (LVIDs), and 43.22% ± 4.67% (LVEF). Group 2 showed similar positive outcomes, with preoperative values of 47.09 ± 5.06 mm (LVIDd), 35.11 ± 5.25 mm (LVIDs), and 50.13% ± 7.25% (LVEF), improving to 42.37 ± 4.18 mm (LVIDd), 31.05 ± 4.19 mm (LVIDs), and 55.33% ± 7.05% (LVEF) at one month postoperatively. Both groups demonstrated significant improvements in left ventricular function and NYHA class, with most patients moving from class III/IV to I/II. Complications were minimal, and no mortality was observed. Conclusion: OPCAB is safe and effective for patients with LVEF 30% - 39% and LVEF ≥ 40%, providing significant short-term functional improvements without increased risk.

Changes in Tear-Film Status and Ocular Surface Disease Index Score Following Prolonged Use of Face Mask

Background: Dry eye is characterized by tear film instability, decreased tear volume and a high Ocular Surface Disease Index (OSDI) score. Face masks have been linked to dry eye complaints in recent studies. Purpose: To evaluate the changes in tear-film status and Ocular Surface Disease Index (OSDI) score following prolonged use of face mask. Design: Cross-sectional study. Method: Patients between 18 to 70 years using masks regularly for at least 2 hours/day for at least 5 days/week from different eye-care centres in Dhaka were included. All subjects were divided into 4 groups. Mask use lasted approximately 2 hours/day in Group 1, 4 hours/day in Group 2, 6 hours/day in Group 3 and 8 hours or more/day in Group 4. Evaluation of symptoms, tear- film stability and tear volume was done by Ocular Surface Disease Index (OSDI) scores, Tear-film Break-Up Time (TBUT) and Schirmer-1 test. Average of right & left eye’s Tear-film Break Up time (TBUT) and Schirmer-1 value were noted. Results: Total 100 patients were enrolled (n = 100). The TBUT (p < 0.001) and Schirmer-1 measurement (p = 0.01) were significantly lesser and Ocular Surface Disease Index (OSDI) score were significantly higher in patients using face-masks for longer time (p < 0.001). Conclusion: Patients who wore masks for prolonged time had tear film instability, reduced tear volume and higher Ocular Surface Disease Index (OSDI) score.