Outcome and factors associated with hospital mortality in patients with impaired left ventricular function undergoing coronary artery bypass grafting: where do we stand?

Impaired ventricular function is a known risk factor for mortality after coronary artery bypass grafting however increasingly more patients with impaired ventricular function are referred for surgery. Currently no large data is available from Pakistan regarding this aspect of coronary surgery. Our objectives were to find out the hospital mortality and mid term functional improvement in patients with impaired ventricular function undergoing coronary artery by pass grafting and identify the risk factors for mortality. Retrospective analysis of preoperative, operative and postoperative variables of patients with impaired ventricular function who were operated for isolated first time coronary artery bypass between October 2006 to April 2009. Total 190 patients with impaired ventricular function underwent isolated first time coronary artery bypass grafting during this period with a male predominance [82.6%]. Mean ejection fraction of the group was 25.4 +/- 5.3%. Mean predicted mortality on logistic Euro score was 10.9 +/- 2.7%. Actual in hospital mortality of the group was 4.7% which is comparable to contemporary published results. Multivariate analysis identified use of intra aortic balloon pump, non use of internal mammary artery and preoperative NYHA functional class as factors associated with mortality. Coronary artery bypass grafting can be performed in patients with impaired ventricular function with acceptable hospital mortality and mid term functional improvement

Bidirectional cavopulomanry shunt for cyanotic heart disease: Surgical experience from a developing country

The importance of bidirectional cavopulmonary anastomosis for palliation of complex cyanotic congenital heart disease is widely recognized. This study was conducted to highlight our surgical experience with this procedure in a developing country. A retrospective study was conducted using medical records at the Aga Khan University Hospital, Karachi, Pakistan. Clinical findings at presentation, anatomical defects seen on transthoracic echocardiography, pre-operative McGoon index, cardiopulmonary bypass time, use of cardioplegia, post-procedure oxygen saturations and complications were evaluated. A total of 8 patients underwent bidirectional cavopulmonary anastomosis. There were 6 males [75%] and 2 females [25%]. Ages and weights at operation averaged 5.7 +/- 3.7 years [range 2-14 years] and 18.6 +/- 10.4 kg [range 8.5-35.5 kg] respectively. The most common symptoms were the presence of cyanosis in all [100%] patients followed by recurrent respiratory tract infections in 3 [37.5%] patients. Transthoracic echocardiography revealed 6 [75%] patients with atrial septal defects, 5 [62.5%] with tricuspid atresia, 3 [37.5%] with ventricular septal defects, 3 [37.5%] with malposition of great vessels, 2 [25%] with pulmonary stenosis and 2 [25%] with double inlet left ventricles. The mean pre-procedure McGoon index was 2.1 +/- 0.5 [range 1.37-2.80]. All patients received cardioplegia. Cardiopulmonary bypass was used in all patients for a mean time of 154.1 +/- 83.6 minutes [range 60-298 minutes]. All patients were ventilated for a mean period of 1.5 +/- 0.7 days [range 1-3 days]. The ICU stay was 3.0 +/- 0.6 days [range 2-5 days] with a total hospital stay of 9.8 +/- 3.8 days [range 7-18 days]. The mean post-procedure oxygen saturation was 82.6 +/- 3.5% [range 76-86%]. The most common post-operative complication was supraventricular arrhythmia in 2 [25.0%] patients. There were no intra-operative or early [within 7 days of procedure] deaths. One patient developed pulmonary artery hypertension and died 23 months later due to cardiac arrest. Patients tolerated the procedure well. After a mean follow-up of 10 months, 6 patients were assessed to be in New York Heart Association [NYHA] functional class I and one patient in NYHA class II. Clinical and post-procedural data gathered from our experience confirms the safety of bidirectional cavopulmonary anastomosis