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