Endoscopic Versus Open Radial Artery Harvesting Used in Coronary Artery Bypass Grafting, Our Experience at Queen Alia Heart Institute Endoscopic versus open radial artery harvesting used in coronary artery

Coronary artery stenosis bypass by using radial artery is good techniques which have longer outcomes. In coronary artery bypass grafting (CABG) the radial artery has several advantages. The radial artery has a thick muscular wall which is more susceptibleto contraction from the competitive flow. As compared to the open harvesting technique endoscopic harvest of the radial artery has long lasting cosmetic results it also reduces the post-operative complications. The purpose of the study is to compare the two harvesting techniques and compare the short term and long term results related to intra-operative and post-operative outcomes Methods: This is retrospective study (In Queen Alia Heart Institute, Amman, Jordan) to compare endoscopic radial artery technique versus open technique by reviewing patients files through a period between June 2013 and June 2018. Total 50 patients of CABG surgery was selected they were divided into two groups. Group A includes endoscopic radial harvest (n= 10) and Group B includes open harvest (n=40). Data was collected on predesigned Performa. Data were entered and analyze through IBM SPSS 22.0 Results: There was insignificant dissimilarity between the pre-operative outcomes between groups. The Post-operative outcomes were almost same in both groups except hand numbness (P-value<0.005). The comparison of intraoperative outcomes like harvest time between both groups indicate that the mean harvest time in group A was shorter than group B (39.20 + 3.73 Vs 51.90 + 2.09, P-value=0.000). The operative time in group A was higher than the group B (306.0 + 11.6 Vs 278 + 4.25 p-value=0.00). The hospital stays in both groups were insignificantly different (p = 0.09) Conclusions: Endoscopic radial artery harvest is best suited technique for CABG surgery as it significantly decreases the harvest time as well as hospital stay. It is also proven that it is safer, less painful and better wound appearance technique with exceptional outcomes based on positive surgical experience.

Extraction and Evaluation of Secondary Metabolites As Green Antiotensin Converting Enzyme Ace Inhibitor.

Secondary metabolites, substantially available in the medicinal plants, have divulged their pharmacological properties and can be used in its isolated form or as integral component of the plant‟s part, to cure a variety of disorders. High blood pressure is considered as silent killer as it sneaks up in the body and may leads to serious cardiovascular disorders. Many allopathic antihypertensive medicines are presently available but these are taking their toll in the form of serious side effects. Therefore, the present study was designed for extraction and evaluation of plant‟s secondary metabolites as green Angiotensin Converting Enzyme (ACE) inhibitors for management of hypertension. In the first phase of this research, aqueous and ethanol extracts of 22 plants were initially screened as green ACE inhibitors. Among them four plants Coriandrum sativum, Amomum subulatum, Rauvolfia serpentina and Curcuma longa showed highest ACE inhibition potential. Secondary metabolites were extracted from these four medicinal plants and evaluated for ACE inhibition potential. The highest ACE inhibition potential was observed with flavonoid (81.4±0.48%) of Coriandrum sativum, tannin (77.9±0.24%) of Amomum subulatum, flavonoid (79.9±0.42%) and tannin (88.3±0.26%) of Rauvolfia serpentina and alkaloid (44.4±1.32%) of Curcuma longa. Plants are traditionally recognized for their synergic therapeutic effects, therefore, combinations of plants and their secondary metabolites were evaluated for synergistic ACE inhibition potential. The results revealed that the combination No.1 comprising of Rauvolfia serpentina and Curcuma longa (RS+CL) exhibited significant ACE inhibitory activity (65.08±0.33%) with IC50 value of 73.67μg/mL. The combination No. 13 of secondary metabolite comprising of tannins and flavonoids of Rauvolfia serpentina and alkaloids of Curcuma longa (TRS+FRS+ACL) showed highest ACE inhibition potential (69.64±0.80%) with IC50 value of 39.67μg/mL. Secondary metabolites present in combination No. 13 were further fractionated through column chromatography. Different fractions of flavonoids, tannins and alkaloids were collected, but among them only F3 fraction of flavonoids, T3 fraction of tannins of Rauvolfia serpentina and A6 fraction of alkaloids of Curcuma longa showed ACE inhibition potential. In 2nd phase of the study, characterization of five secondary metabolites fractions extracted from four selected medicinal plants and secondary metabolites present in combination No. 13 were performed by LC-ESI-MS/MS technique to find out the actual bioactive compounds responsible for ACE inhibition potential. The ACE inhibitors identified from flavonoids fraction were included pinocembrin, apigenin, pseudobaptigenin, quercetin, myricetin-3-O-glucoside, quercetin- dimethyl ether-O-glucuronide, quercetagetin, Luteolin-7-O-glycoronyl and quercetin-3-O-hexose-pentoside. Tannins fraction contained ellagic acid, megiferin gallate, prodelphinidin B4, tri galloyl glucose and geraniin as ACE inhibitors. Pyrazolo[1,5-a]pyridine,3,3a,4,7-tetrahydro-3,3-dimethyl;(3aS) and 2-(2‟-methyl-1‟-propyl)-4, 6-dimethyl-7-hydroxyquinoline were identified as alkaloidal ACE inhibitors. In the 3rd phase of this study, the combination No. 1 of plant (RS+CL) and combination No. 13 of secondary metabolites (TRS+FRS+ACL) were investigated for in vivo antihypertensive potential through spontaneous induction of hypertension by two kidney one clip (2K1C) renal artery ligation method. In vivo trial revealed that the combination No. 13 of secondary metabolites showed comparatively better antihypertensive potential as compared to the combination No.1 of whole plants. It is pertinent to mention that the antihypertensive potential of the isolated secondary metabolites was better even than the standard drug (Captopril) which was used as reference.