ABSTRACT
Objective: To build a clinical predictive model to determine the need for transfusing blood and its products in coronary artery bypass grafting [CABG] procedures in South East Asian population
Study Design: Analytical study
Place and Duration of Study: Section of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, from January 2006 to October 2014
Methodology: Information on pre-, intra- and postoperative variables were collected for all adult patients who underwent on-pump CABG. The patients grouped into those who received blood and its components, and those who did not. A univariate as well as multivariate logistic model was built to determine the predictors of transfusion
Results: A total of 3,550 patients underwent CABG and males were dominant in both groups [75 vs. 93%]. The transfusion rate was 56.4% [n=2001]. Age [adjusted OR 1.03, p < 0.001], obesity [1.50, p=0.001], tobacco use [1.29, p=0.001], and male gender [4.51, p < 0.001] found to be a stronger predictor. Among preoperative comorbidities, diabetes [1.20, p=0.016], myocardial infarction [1.22, p=0.009], preoperative creatinine [1.12, p=0.033], and left main vessel disease of > 50% [1.49, p < 0.001] were independently associated with the outcome. Compared to elective cases, transfusion rates were high in urgent and emergent cases [OR: 1.93 and 3.36 respectively, p < 0.001 for both]
Conclusion: Age, male gender, obesity, tobacco use, diabetes, myocardial infarction, high creatinine, urgent and emergent cases were independent predictors of transfusion in CABG procedure. This model can be utilized for preoperative risk stratification of patients and their management to improve the outcomes
ABSTRACT
Introduction: Cardiac tumors constitute only 0.2% of all tumors. Primary cardiac tumors occur infrequently with an incidence of 0.0017% to 0.19%, estimated on autopsies performed in non-selected populations. Left atrial myxomas are the most prevalent [75% to 80%] and right atrial are less common [10% to 18%]. Surgical excision yields an excellent prognosis and recurrence rate of only 3% with a very low morbidity and mortality
Objective: We aimed to review our experiences with this rare entity and highlight the various aspects of myxoma presentation, diagnosis and outcomes
Methodology: A retrospective chart review done on patients underwent excision of myxoma with histopathological confirmation since January 1991 till December 2015. Standard surgical approach adopted was single atrial, augmented with Biatrial approach where needed
Results: A total 42 cases were identified and 28 cases with complete data were included in the analysis. Mean age was 54.4 [ +/- 17.7] years, with female predominance [58% vs. 42%]. Preoperative comorbidities included hypertension [39.2%], diabetes [28.5%], IHD, dyslipidemia, and COPD [10.7%] that were comparable among gender. The mean dimension of myxoma measured on echocardiography was 4.9x3.5x2.7 cm. Sixty four percent had left sided and 35.7% had right sided myxoma. Most common symptom was dyspnea [71%], constitutional symptoms [39.3%] and stroke in [18%]. Echo being the diagnostic modality of choice. Post-operative complications occurred in 6 patients and mortality occurred in 2 [7.2%]. Mean post-operative follow up was 8.3 months and 10 years telephonic follow up completed in [32%] cases, with 2 late non-cardiac mortalities
Conclusion: Our results showed that the prevalence of cardiac myxoma is comparable with global estimates. Female gender was predominant and age and right atrial myxoma was slightly higher in our sample compare to other published literature. Myxoma can be excised successfully with a low rate of morbidity, mortality and recurrence