Early Results of Coronary Artery Bypass Graft (CABG) in Patients with Low Ejection Fraction

ELShafey, Wassam ELDin Hadad; Elnagar, Taher Mohamed Ahmed; Kamal, Ahmed A; Kamal, Abdalla Mostafa

doi:10.4236/wjcd.2020.105030

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…Similar to our findings, Maltais et al evaluated 1250 patients who underwent off-pump CABG and showed that major adverse cardiac events (MACEs) were not significantly different in patients with LVEF < 35% and LVEF ≥ 35% after adjustment for potential risk factors [ 20 ]. However, another study conducted by El-Shafey et al evaluated 170 patients who underwent CABG and showed that non-fatal CCVE occurred more significantly in patients with LVEF < 40% [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Significance of preoperative left ventricular ejection fraction in 5-year outcome after isolated CABG

Fallahzadeh

Sheikhy

Ajam

et al. 2021

J Cardiothorac Surg

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Background Pre-operative ejection fraction (EF) and comorbidities affect post-op outcomes. We aimed to compare the mortality and adverse events of patients with different baseline EF and also to evaluate the distribution of comorbidities in each EF group. Methods A total of 20,937 patients who underwent isolated coronary artery bypass graft (CABG) surgery from January 2006 to December 2016 was included. Patients were divided into three groups based on their pre-operative left ventricular EF as follows; (1) Normal: EF ≥ 50%; (2) Mild to moderately reduced: 50% < EF ≤ 35%; and (3) Severely reduced: EF < 35%. The backward elimination method was considered for multivariate Cox-regression analysis to locate predictors of mortality and non-fatal cerebro-cardiovascular events (CCVEs). The median follow-up time was 5.61 [3.12–8.0] years. Results The mean age in the total population was 60.94 ± 9.51 years and 73.6% of the total population was male. Diabetes mellitus was the common risk factor of mortality and CCVE in all EF groups. Impaired renal function (GFR < 60 ml/min) was associated with a higher risk of mortality after CABG regardless of EF level. The median 5-year mortality rate in patients with normal EF, mild-moderately reduced EF and severely reduced EF were 9.5%, 12.8%, and 22.7% respectively (P < 0.001). Although the trend of CCVEs was higher in severe left ventricle (LV) dysfunction, it was not statistically significant (p = 0.071). Conclusion Patients with severely reduced EF are at higher risk of mortality after CABG compared to those with higher EF levels; however, the rate of CCVEs may not be necessarily higher after adjustment for multiple pre-operative comorbidities.

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Section: Discussionmentioning

confidence: 99%

Significance of preoperative left ventricular ejection fraction in 5-year outcome after isolated CABG

Fallahzadeh

Sheikhy

Ajam

et al. 2021

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…Similar to our ndings, Maltais et al evaluated 1250 patients who underwent off-pump CABG and showed that major adverse cardiac events (MACEs) were not signi cantly different in patients with LVEF<35% and LVEF≥35% after adjustment for potential risk factors (18). However, another study conducted by El-Shafey et al evaluated 170 patients who underwent CABG and showed that non-fatal CCVE occurred more signi cantly in patients with LVEF <40% (19).…”

Section: Discussionmentioning

confidence: 99%

Significance of Preoperative Left Ventricular Ejection Fraction in 5-year Outcome After Isolated CABG

Fallahzadeh¹,

Sheikhy²,

Ajam

et al. 2021

Preprint

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Background: Pre-operative ejection fraction (EF) and comorbidities affect post-op outcomes. We aimed to compare the mortality and adverse events of patients with different baseline EF and also to evaluate the distribution of comorbidities in each EF group. Methods: A total of 20,937 patients who underwent isolated coronary artery bypass graft (CABG) surgery from January 2006 to December 2016 was included. Patients were divided into three groups based on their pre-operative left ventricular EF as follows; 1) Normal: EF ≥ 50%; 2) Mild to moderately reduced: 50% < EF ≤ 35%; and 3) Severely reduced: EF< 35%. The backward elimination method was considered for multivariate Cox-regression analysis to locate predictors of mortality and non-fatal cerebro-cardiovascular events (CCVEs). The median follow-up time was 5.61 [3.12- 8.0] years. Results: The mean age in the total population was 60.94 ± 9.51 years and 73.6% of the total population was male. Diabetes mellitus was the common risk factor of mortality and CCVE in all EF groups. Impaired renal function (GFR<60 ml/min) was associated with a higher risk of mortality after CABG regardless of EF level. The median 5-year mortality rate in patients with normal EF, mild-moderately reduced EF and severely reduced EF were 9.5%, 12.8%, and 22.7% respectively (P< 0.001). Although the trend of CCVEs was higher in severe left ventricle (LV) dysfunction, it was not statistically significant (p = 0.071). Conclusion: Patients with severely reduced EF are at higher risk of mortality after CABG compared to those with higher EF levels; however, the rate of CCVEs may not be necessarily higher after adjustment for multiple pre-operative comorbidities.

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“…[12] Angka mortalitas pasien pasca operasi BPAK dalam penelitian ini adalah 8,33%, dengan keempat kasus berasal dari kelompok on pump. Data tersebut berbeda dengan hasil penelitian lain, seperti El-Shafey [27] yang mencatat angka mortalitas 8,3%, Santos [28] dengan 8,7%, dan The Society of Thoracic Surgeons (2019) dengan mortalitas 1,8% selama perawatan dan 2,3% dalam 30 hari pasca operasi BPAK.…”

Section: Pembahasanunclassified

“…El-Shafey [27] mencatat faktor-faktor yang mempengaruhi tingginya angka mortalitas, termasuk jenis kelamin perempuan, usia tua, komorbid diabetes melitus, penggunaan mesin pintas jantung paru yang lama, waktu klem aorta yang lama, dan durasi operasi yang panjang. Artikel Hardiman [29] menyebutkan karakteristik pasien, komorbiditas, dan status kesehatan sebelum operasi sebagai faktor mortalitas yang umum dilaporkan.…”

Section: Pembahasanunclassified

Karakteristik Pasien Penyakit Jantung Koroner yang Menjalani Bedah Pintas Arteri Koroner di Medan 2022

Fahriza,

Siregar

2024

SCRIPTA SCORE Sci Med J.

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Background: Coronary Heart Disease (CHD), the leading global cause of death, stems from artery constriction due to fat deposition and vessel stiffness, leading to insufficient blood flow to the heart muscles. Despite numerous studies on CHD characteristics, none reflect the latest data specific to North Sumatra, contributing to 32% of global deaths. Objective: To describe the characteristics of CHD patient that underwent coronary artery bypass graft (CABG) in 2022 at RSUP Haji Adam Malik Medan. Methods: This descriptive research with cross-sectional design was done to CHD patients that underwent CABG operation with total sampling technique and used medical record data that was taken and grouped to characteristics before, during, and after the surgery. Results: Out of 48 complete medical records, majority of patients are in the age range of 48-65 years old (73%), male gender (85.4%), hypertension and/or type 2 diabetes patient (70.9%), abnormal lipid profile (93.8%), operation duration 240309 minutes (66.7%), normal ejection fraction (56.3%), in use of cardiopulmonary bypass machine (on pump) during operation (54.2%), CPB time 118-159 minutes (53.8%), Aox time 59-88 minutes (50%), in use of 3 grafts (56.3%), normal kidney function after the operation (83.3%), abnormal routine blood profile (53.88%), and without complications (66.7%). Conclusion: In this study, the average age of patients was 56, mostly male, with abnormal lipid profiles. The prevalent comorbidities were hypertension and/or type 2 diabetes. Operations averaged 284.75 minutes, using 3 grafts, with 43.7% having lowered ejection fraction. Arrhythmia was the most common postoperative complication. Keyword: CABG, Characteristics, CHD Latar Belakang: Penyakit Jantung Koroner (PJK), penyebab utama kematian global, disebabkan oleh penumpukan lemak dan/atau kekakuan pembuluh darah, mengurangi perfusi otot jantung dan menyumbang 32% angka kematian dunia. Banyak penelitian karakteristik pasien PJK, tetapi kurangnya data terbaru karakteristik PJK di Sumatera Utara menjadi perhatian. Tujuan: Untuk mendeskripsikan karakteristik pasien PJK yang menjalani bedah pintas arteri koroner pada tahun 2022 di RSUP Haji Adam Malik Medan. Metode: Penelitian deskriptif dengan desain cross-sectional ini dilakukan pada pasien PJK yang menjalani operasi bedah pintas arteri koroner (BPAK) dengan teknik total sampling serta menggunakan data rekam medis yang diambil dan dikelompokkan menjadi karakteristik sebelum, selama, dan setelah operasi. Hasil: Dari 48 rekam medis lengkap, pasien paling banyak pada kelompok usia 48-65 tahun (73%), jenis kelamin laki-laki (85,4%), penderita hipertensi dan/atau DM tipe 2 (70,9%), profil lipid abnormal (93,8%), durasi operasi 240-309 menit (66,7%), fraksi ejeksi normal (56,3%), menggunakan mesin jantung paru (on pump) selama operasi (54,2%), CPB time 118-159 menit (53,8%), Aox time 5988 menit (50%), menggunakan 3 graft (56,3%), fungsi ginjal normal paska bedah (83,3%), profil darah rutin abnormal (58,33%), dan tidak mengalami komplikasi (66,7%). Kesimpulan: Pasien penelitian ini rata-rata berusia 56 tahun, didominasi oleh laki- laki, mayoritas memiliki profil lipid abnormal, dengan komorbid terbanyak adalah hipertensi dan/atau DM tipe 2. Mayoritas pasien tidak mengalami komplikasi paska pembedahan. Komplikasi tersering adalah aritmia. Kata Kunci: BPAK, Karakteristik, PJK

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Early Results of Coronary Artery Bypass Graft (CABG) in Patients with Low Ejection Fraction

Cited by 4 publications

References 13 publications

Significance of preoperative left ventricular ejection fraction in 5-year outcome after isolated CABG

Significance of preoperative left ventricular ejection fraction in 5-year outcome after isolated CABG

Significance of Preoperative Left Ventricular Ejection Fraction in 5-year Outcome After Isolated CABG

Karakteristik Pasien Penyakit Jantung Koroner yang Menjalani Bedah Pintas Arteri Koroner di Medan 2022

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