Perioperative outcomes of coronary artery bypass graft surgery in Johannesburg, South Africa

Abstract

Background The perioperative complications in patients with coronary artery disease undergoing coronary artery bypass graft (CABG) surgery have been reported predominantly from developed countries, with a paucity of data from sub-Saharan Africa. We aim to report on the clinical characteristics and perioperative complications in patients with obstructive coronary artery disease, managed with CABG surgery at a tertiary academic hospital in Johannesburg, South Africa. Methods We retrospectively reviewed data from adult patients who underwent CABG surgery during a 17-year period (January 2000 – December 2017). Data was collected from the cardiothoracic surgery department’s pre- and postoperative reports, the cardiology department’s medical records, and anaesthesiology’s intra-operative reports. We collected demographic, biochemical, clinical, surgical, echocardiographic, and angiographic data. Outcomes data collected included perioperative complications and mortality. Results We analysed 1218 consecutive patient records. The study cohort consisted of 951 (78.1%) males, and the mean age was 60.1 ± 10.1 years. During the study period, 137 (11.2%) patients demised with cardiac and sepsis-related causes of death accounting for 49.6 and 37.2%, respectively. Other perioperative complications included excessive bleeding in 222 (18.2%), prolonged ventilation (exceeding 48 h) in 139 (11.4%), and sternal sepsis in 125 (10.3%). On univariate logistic regression analysis, advanced age, a lower left ventricular ejection fraction, smoking, increased cardiopulmonary bypass (CPB) time, and a higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) II were all significantly associated with mortality. The EuroSCORE II [OR: 0.15 95%CI: 0.09–0.22; p = 0.000], and prolonged CPB time [OR: 0.01 CI: 0.00–0.02; p = 0.000] were independent predictors of in-hospital all-cause mortality. Conclusions In our study, the crude perioperative mortality rate was 11.2%. Our mortality rate was significantly higher than the mortality rates reported in other developed and developing countries. To better understand the factors driving this high mortality rate, a prospective outcomes registry has been initiated, and this promises to inform on our contemporary mortality and morbidity outcomes.

Progress and Success of Coronary Artery Bypass Graft in TANZANIA, A Retrospective Review of Patients Operated at Jakaya Kikwete Cardiac Institute: MUHIMBILI NATIONAL HOSPITAL

“…Open heart surgery though started at JKCI in May 2008 with defect closure and valvular heart surgery, coronary revascularization was not started until 2016 when the first case was operated by the local surgical team. Intraoperative mortality in CABG varies from centre to centre, while other series report 2.3%-3% mortality rate, the intraoperative mortality rate at the centre was 1.4%, that did not differ from other series [2,9]. Reported overall mortality rate varies from centre to centre, a mortality of 8.7% and 11.7% has been reported in other series [7,8].…”

Contemporary Neuroprotection Strategies during Cardiac Surgery: State of the Art Review

“…There is a paucity of studies reporting neurological complications after cardiac surgery in patients residing in low and middle-income countries (LMIC). In a retrospective chart analysis of 1218 consecutive patients referred for CABG surgery in Johannesburg, the perioperative stroke rate was 1.2% [ 20 ]. Moreover, one year after the onset of a stroke, the annual cost in British pounds per person is estimated at GBP 18,081, increasing to GBP 22,961 in patients older than 84 years [ 21 ].…”

Neo-onset myocardial infraction in patients undergoing coronary artery bypass graft with and without long cross clamp time.

“…This injury can cause myocardial shock, arrhythmia, early postoperative myocardial performance alterations requiring inotropic support, and acute lung injury requiring various mechanical ventilation durations. 1,2 Peri-operative MI is a highly significant complication that can occur following CABG, with incidence of ranging from 5 to 30% varying with the hospital circumstances and patients comorbid conditions. Additionally, factors such as inadequate myocardial protection, reperfusion injury, or prolonged cross clamp time can also contribute to its occurrence.…”