RESUMO
Introduction The aim of this research is to evaluate the in-hospital and early outcomes of the first 100 adult cardiac surgeries performed at a newly developed satellite center in Sukkur, Pakistan. Methods This is an audit of the first 100 adult cardiac surgeries performed at a newly developed satellite center of the National Institute of Cardiovascular Diseases (NICVD) at Sukkur, Pakistan, from March 2018 to November 2018 with 12 months of post-operative follow-up. Patients were offered off-pump coronary artery bypass (OPCAB), on-pump coronary artery bypass (ONCAB), mitral valve replacement (MVR), aortic valve replacement (AVR), minimally invasive cardiac surgery (MICS), and congenital adult congenital heart disease (ACHD) procedures by expert faculty of NICVD with a minimum of five years of post-fellowship experience. Results The mean age was 47.11 ± 14.6 years, with a male predominance of 77%. Hypertension and smoking were the most common risk factors that were observed in 32% and 33%, respectively, followed by diabetes and dyslipidemia with a frequency of 20% and 9%, respectively. The mean EuroSCORE (European System for Cardiac Operative Risk Evaluation) II for this patient cohort was 1.165 ± 0.50, with a maximum score of 2.3 in one patient. Out of 100 procedures, 51 were ONCAB, 19 were OPCAB, 16 were MVR, three were AVR, nine were ACHD, and two were MICS. Survival status post-operative as well as after one year was 100%. The frequency of post-operative bleeding was 7%, mean post-operative mechanical ventilation time was 213 ± 273 hours, and in-hospital stay was 5.41 ± 0.165 days. Lost to follow-up at one year was 4% (four). During the follow-up assessment, 39.5% of the patients had complained of mild-to-moderate intensity retrosternal pain and 4.2% had superficial surgical site infection of the sternal wound. A significant improvement in functional class was observed in 38.5% of patients, whereas 4.2% (four) had a significant drop in functional class post-operatively. Conclusion Providing tertiary care and early cardiac surgical facility to the people of Sukkur at their doorstep, in a newly developed satellite center, has resulted in improved outcomes, early quality treatment facility, and avoidance of long travel time.
RESUMO
Background Isolated mitral valve replacement is a routinely performed procedure at our institute due to higher prevalence of rheumatic heart disease in every age category. Hardly any researches are available that dictate the predictors of surgical mortality in isolated mitral valve procedure. The aim of this study was to identify the most prevailing pre-operative factors in patients who had mortality after isolated mitral valve surgery. Methodology A retrospective observational study of two years was performed from January 2018 to December 2019 at the Adult Cardiac Surgery Department of a tertiary care cardiac center in Karachi, Pakistan. Patients of either gender of age ranging from 16 to 65 years who had mortality within 30 days after isolated mitral valve surgery were included in the study. Variables assessed from records were anemia, New York Heart Association (NYHA) functional classification, prolonged symptoms, poor nutritional status, degree of left ventricular (LV) dysfunction, valve pathology, pulmonary artery hypertension, and cardiac arrhythmias. Results We report our isolated mitral valve mortality rate of 5.5% (38/697) in the two-year duration. The most commonly encountered pre-operative factors were severe mitral regurgitation and pulmonary artery hypertension, which were observed in 32 (84.2%) and 23 (60.5%) patients, respectively. Other factors that were common to these patients were higher NYHA functional class (class III in 23 [60.5%] and class IV in 9 [23.7%]), prolonged duration of symptoms (20 [52.6%]), and right ventricular dysfunction (moderate in 21 [55.3%] and severe in 7 [18.4%]). Conclusions The outcome of our study suggests that severe mitral regurgitation, pulmonary artery hypertension, high NYHA functional class, LV dysfunction, and prolonged symptoms were the common predisposing factor in patients with peri-operative mortality after isolated MVR.
