Azhar Rashid, Kamal Saleem, Syed Afzal Ahmad, Bilal Bin Yousaf, Asif Ali Khan, Afsheen Iqbal, Inam Ullah Khan, Muhammad Waseem.
Coronary artery surgery in the presence of left ventricular dysfunction
Pak J Cardiol Sep - Dec 2005;16(3):111-20.
Armed Forces Institute of Cardiology, Rawalpindi
Objectives: To identify the factors affecting mortality after Coronary artery bypass grafting (CABG) in patients with an ejection fraction (EF) of 0.25 or less. Design: Case - review analytical study Place and duration of study: Armed Forces Institute of Cardiology / National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi, from 1st January 2001 to 31st December 2004. Methods: Patients who under went CABG and had an EF of 0.25 or less were studied. Patients were divided into two groups. Group-I included survivors and group-II included non-survivors. Determinants of postoperative death were identified by analyzing univariate and multivariate association between various preoperative, operative and post operative variables and patients death. Results: 62 patients were studied. Over all hospital mortality was 16.1%. Mortality in year 2001 was 37.5% and in year 2002 to 2004 it was (8.6%). Uni-variate analysis of concomitant varibale for the entire study period showed diabetes, ireversible ischemia, higher NYHA class, congestive heart failure; poor target vessels, non use of preoperative IABP, unstable angina and year of operation 2001 as statistically significant factors for higher mortality. Non-use of preoperative IABP, higher NYHA class and poor target vessels were statistically significant variables after multivariate analysis. Conclusion: A management strategy that addressed proper case selection and judicious preoperative use of IABP helped in improving outcome after CABG in patients with an ejection fraction of 0.25 or less. Presence of salvageable myocardium with operable vessels and use of preoperative IABP had a favourable impact on outcome after CABG in this subset of patients in our set up.
Category: Cardiac Surgery
Keywords: Coronary Artery Bypass Grafting. CABG. Ejection Fraction. Left Venticular Dysfunction.
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