Coronary artery bypass graft surgery: results of the first 309 operations in Bahrain

ABSTRACT

Between November 1992 and June 1995, 309 consecutive patients underwent first-time coronary artery bypass graft [CABG] operation at the Mohammad bin Khalifa bin Sulman Al Khalifa Cardiac Centre. The male female ratio was 5.7 1, mean age 54.6 years. 41% of patients had urgent or emergency operation, the remainder were elective, 41% were diabetic, 45% hypertensive, 21% hyperlipidaemic, 15% hypercholesterolaemic and 27% had unstable angina, 12% had unstable post-infarction angina within 6 weeks of infarction. Seventeen patients 6% had significant recurrent pulmonary oedema as part of their presentation and 44 [13%] had significant mitral regurgitation. Mean ejection fraction from biplane cineangiography was 41%. A total of 931 distal anastomoses were constructed mean 3.0 grafts per patient. There were 11 hospital deaths [3.56% mortality] and 3 late deaths [1% of hospital survivors] though only 2 late deaths were cardiac. Intra-aortic balloon pumping was used preoperatively in 3 patients [1%] and post-operatively in a further 21 patients [6.7%]. To date, July 1995, no patient has required re-operation though 5 patients have undergone postoperative angioplasty of stenosed internal mammary bypass grafts to the left anterior descending coronary artery in 2 patients and to vessels not significantly diseased or bypassed at the time of operation in 3 patients. All angioplasties were successful in relieving symptoms. The linearised rate of late death, non-fatal myocardial infarction and recurrent angina were 0.8%, and 4.1% per patient year respectively. Actuarial survival free of all cardiac events was 91.2%. Ninety two% of patients out of hospital for three or more months have returned to full-time employment or full activities and only 11 patients are on anti-anginal medical therapy. Despite the diffuse nature of the coronary disease seen in Bahrain and the frequency of previous infarction, reduced ejection fraction, symptomatic pulmonary congestion, diabetes, hypertension and obesity, results with CABG are acceptable in terms of operative mortality and excellent in terms of freedom from 'late' complications and functional rehabilitation