Frequency and predictors of cognitive decline in patients undergoing coronary artery bypass graft surgery

To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery [CABGS]. An observational study. The National Institute of Cardiovascular Diseases [NICVD], Karachi, from December 2008 to December 2009. Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction [MI] within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline. One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 [84.3%] males and 21 [15.7%] females, with mean age of 53.7 +/- 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline. Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time

Early effects of coronary artery bypass grafting on left ventricular regional wall motion abnormalities

To determine the early effects of Coronary Artery Bypass Grafting [CABG] on regional left ventricular wall motion abnormality in patients undergoing surgery for proven Coronary Artery Disease [CAD]. Quasi-experimental study. Department of Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi. from October 2005 to April 2006. Patients and Methods: A total of a 100 adult patients who underwent elective CABG were selected. Pre-operative echocardiography was done to note if segmental left ventricular wall motion at basal, mid and apical levels were normal, hypokinetic, akinetic, dyskinetic, or aneurysmal. Postoperative echocardiography was done between 4th and 6th day and change in left ventricular segmental wall motion was noted. Seventy-five patients [n=75] were included in the analysis. These results showed that effect of CABG on anterior segmental wall motion abnormalities was insignificant [p=.609], the effect on the anterior IVS showed deterioration of segmental wall motion and this effect was significant [p=.001], effect is insignificant on anteriolateral segmental wall motion abnormalities [p=.078], normal pre-operative segments in posterior wall showed stability [p=.664] while disappearance of dyskinetic, reduction in akinetic segments postoperatively and inferior wall motion have same effects as of posterior wall. Comparison of pre-operative and postoperative echocardiographic data revealed early improvement in segmental wall motion of posterior and inferior wall, while alterations in segmental wall motion of anterior, anterior-lateral and septal wall. Myocardial revascularization by CABG improves early left ventricular regional wall motion abnormalities where SVG is used as conduit for revascularization whereas no significant improvement occurs in early segmental wall motion in areas revascularized by LIMA

Coronary artery by pass grafting in patients with renal dysfunction

This study was planned [a] to document the hospital morbidity and mortality of patients undergoing CABG surgery, who had preexisting renal impairment, [b] to document further deterioration in renal dysfunction in these patients.[c] to evaluate the safety profile of coronary artery by pass grafting [CABG] surgery in such patients. A total of 63 patients with documented chronic renal dysfunction underwent CABG. These patients were divided into three groups; [1] Those with serum creatinine level up to 3.5mg%. [2] Those with serum creatinine level more than 3.5mg%, and [3] those patients already on regular haemodialysis. The commonest cause of renal impairment was diabetes mellitus. Most of the patients did very well after surgery. Renal function deteriorated in significant number of patients. All these patients required an extended I. C. U and hospital stay. Low cardiac output, need for prolonged ventilation, fluid overload, thin coronaries and obesity were found to be the major risk factors for deterioration in renal function

Coronary artery bypass grafing in young adults

Atherosclerotic coronary artery disease in younger patients is different than that in older age group. As a result Coronary Artery Bypass Grafting [CABG] among such patients carries other considerations. The purpose of this study was to document the early surgical results of patients under the age of 35 years, under going CABG in mixed Pakistani population. Secondly, to examine the etiological factors and the issues related to psychological, social and sexual disturbances after surgery. Finally, to recommend a strategy for future management. Methods. Hospital data of all the patients under the age of 35 years undergoing CABG from January 2001 to December 2002, at National Institute of Cardiovascular Diseases, Karachi, was scrutinized. Various parameters were compared with those of older patient population, reported by our centre, being taken as a control. A total of 87 patients underwent surgery, 82 were males and 5 were females. The age range from 21 to 35 years. Risk factors included family history of coronary Artery disease in 74%, smoking in 86%, familial hypercholesterolemia in 29%, diabetes mellitus in 59% and hypertension in 42%. There were two hospital deaths. Post-operative morbidity included cardiac [17%], pulmonary [10%], infections [6%] and renal [1%]. Conclusion-Short term results in this patient population were comparable to those of older age group. Psychosocial and sexual dysfunction were more prominent in this patient population. Now compliance for secondary prevention was more prevalent in this age group. An organized, multi disciplinary approach is required to tackle various issues of this age group

Surgical revascularization: hospital outcomes

Coronary Artery Bypass surgery was first started in Pakistan in NICVD Karachi. The purpose of this retrospective study is to document the total number of CABG done during the last 25 years at NICVD as regards their mortality and morbidity+ Files of all patients undergoing CABG between January 1977 to December 2001 were reviewed for details of surgery as well as outcome and complications during the hospital stay. A total of 4711 patients including 4437 males and only 273 females [5.7 percent] underwent CABG. All patients had angina pectoris and 942 patients [19.9] also had symptoms of heart failure. A total of 382 patients died [8.1 percent] and 24 percent patients had other complications. In the recent years mortality has been reduced to 3.9 percent. CABG sugery is now a well-established treatment for multi-vessel occlusive coronary artery disease. Short-term morbidity and mortality have declined over the years

Coronary artery bypass grafting surgery: a 22 years experience

This study presents the results of 3011 patients who underwent coronary artery bypass grafting [CABG] surgery at National Institute of Cardiovascular Diseases [NICVD], Karachi, from 1977 to 1998. Of the 3011 patients, 81 percent had triple vessel disease. A total of 9964 grafts were done in these patients with an average of 3.3 grafts per patient Post-operatively, morbidity was comparable to the western data. However, the incidence of post-operative wound infection was much higher. Mortality was 9.4 percent daring the first 5 years of study. It has dropped down to 3.2 percent in recent years