Mudassir Iqbal Dar, Asim Hassan Dar, Mansoor Ahmad.
Low flow IMA its response to topical vasodilators and its effect on patients outcome in ABG surgery.
Pak Heart J Jan ;49(4):158-63.

Objective: To determine the frequency of low flow IMA, the effect of topical vasodilators, its use on LAD and immediate post-operative outcome. Methodology: This cross-sectional study was conducted at Dow University Health Sciences, Karachi, from 1st January 2012 to 31st December 2014. Data was collected of patients who underwent CABG. Free flow of IMA was measured immediately after harvesting with a syringe. Data was analysed on SPSS 15 with sample t test used for comparison. P-value of less than 0.05 was considered statistically significant. Results: Total of 158 consecutive patients were included. Males were 81.6%, with mean age of 52 years The mean flow was 11.6+-9.6ml /30 seconds. About 40 patients had IMA flow less than 5ml/30 seconds(25.3%). The low flow IMA did not showed a good response to topical vasodilators and its use on LAD showed significantly higher need of inotropic support(p=0.004), more LCOS (p=0.022), more use of IABP(p=0.028), and higher incidence of atrial fibrillation. The mortality and readmission were also high but not reached to significant levels. Conclusion: Low flow IMA should be used cautiously on LAD. If low flow IMA after harvesting does not give good response to topical vasodilators it may be better to use the vein graft on LAD. If use of low flow IMA necessary than mechanical and pharmacological support should be consider early.

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