Cardiopulmonary Bypass Grafting Surgery in Patients with Reduced Ejection Fraction
International Journal of Medical Science |
© 2023 by SSRG - IJMS Journal |
Volume 10 Issue 4 |
Year of Publication : 2023 |
Authors : Hazem souliman, Mudar Abdullatif |
How to Cite?
Hazem souliman, Mudar Abdullatif, "Cardiopulmonary Bypass Grafting Surgery in Patients with Reduced Ejection Fraction," SSRG International Journal of Medical Science, vol. 10, no. 4, pp. 20-24, 2023. Crossref, https://doi.org/10.14445/23939117/IJMS-V10I4P104
Abstract:
Background: The role of CABG in patients with reduced ejection fraction has been unclear, and several studies have shown that CABG can be performed safely in those patients. Aim: The purpose of this study was to evaluate the final outcome of isolated CABG surgery in patients with reduced EF before surgery. Materials and Methods: This retrospective analytical study involved 350 patients who underwent isolated CABG and were admitted to the Department of Cardiac Surgery, Tishreen University Hospital, Lattakia, during the four-year period 2017-2020. Patients were divided into two groups according to EF: <35%(47 cases) and ≥35%(303 cases), and final outcomes were compared between the two groups. Results: Ages of the study population range from 31 to 84 years, with a mean age of 61.9±6.8. Males represented 71.7% of the patients with a male-to-female ratio of 2.5:1. There was an increase in post-operative EF on average of 4.6% in patients with EF <35%)33.7±1.8 versus 30.5±2.6 before surgery). Lower levels of EF were associated significantly with higher frequency of post-operative use of inotropic agents (12.8 versus 3.3%, p:0.03), reoperation due to bleeding (4.2% versus 1.6%, p:0.04), kidney injury (6.4% versus 0.3%, p:0.01) and mortality (8.5% versus 2.6%, p:0.03). Duration of hospitalization was significantly longer in patients with EF<35%(6.7±2.3 versus 4.2±1.9, p:0.005). In multivariate regression analysis, reduced EF was associated with prolonged use of inotropic agents (OR: 2.7,95% CI: 1.2-9.3, p: 0.0001), kidney injury (OR:2.1,95% CI: 0.9-7.2, p:0.001), reoperation due to bleeding (OR: 2.1,95% CI 1.1-5.7, p=0.01), and mortality (OR:2.2,95% CI: 0.9-5.3, p:0.004).Conclusion: Low ejection fraction at admission is a prognostic factor for morbidity and mortality in patients who underwent CABG surgery.
Keywords:
CABG surgery, Reduced EF, Final outcome.
References:
[1] Clyde W. Yancy et al., “2017 ACC/AHA/HFSA Focused update of the 2013 ACCF/AHA Guidelines for the Management of Heart Failure; A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America,” Circulation, vol. 136, no. 6, pp. e137-e161, 2017.
[CrossRef] [Google Scholar] [Publisher Link]
[2] Kumar Dharmarajan, and Michael W. Rich, “Epidemiology, Pathophysiology, and Prognosis of Heart Failure in Older Adults,” Heart Failure Clinics, vol. 13, no. 3, pp. 417-426, 2017.
[CrossRef] [Google Scholar] [Publisher Link]
[3] Janek Henes, and Peter Rosenberger, “Systolic Heart Failure: Diagnosis and Therapy,” Current Opinion in Anaesthesiology, vol. 29, no. 1, pp. 55-60, 2016.
[CrossRef] [Google Scholar] [Publisher Link]
[4] John H Alexander, and Peter K Smith, “Coronary-Artery Bypass Grafting,” The New England Journal of Medicine, vol. 374, pp. 1954-1964, 2016.
[CrossRef] [Google Scholar] [Publisher Link]
[5] Eric J. Velazquez et al., “Coronary Artery bypass Surgery in Patients with Left Ventricular Dysfunction,” The New England Journal of Medicine, vol. 364, pp. 1607-1616, 2011.
[CrossRef] [Google Scholar] [Publisher Link]
[6] Sean M O'Brien et al., “The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Model: Part 2-Statistical Methods and Results,” The Annals of Thoracic Surgery, vol. 105, no. 5, pp. 1419-1428, 2018.
[CrossRef] [Google Scholar] [Publisher Link]
[7] Veli K Topkara et al., “Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction,” Circulation, vol. 112, pp. 344- 350, 2005.
[CrossRef] [Google Scholar] [Publisher Link]
[8] Graham S. Hillis et al., “Outcome of Patients with Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting, Renal Function and Mortality After 3.8 Years,” Circulation, vol. 114, pp. 414–419, 2006.
[CrossRef] [Google Scholar] [Publisher Link]
[9] Avinash K Inamdar, Shweta Pralhad Shende, and Sanjeevini A. Inamdar, “Outcome of Coronary Artery bypass Graft Surgery in Patients with Low Ejection Fraction,” Medical Journal of Dr. D.Y. Patil University, vol. 10, no. 2, pp. 162-166, 2017.
[CrossRef] [Google Scholar] [Publisher Link]
[10] Wassam El-Din Hadad El-Shafey et al., “Early Results of Coronary Artery Bypass Graft (CABG) in Patients with Low Ejection Fraction,” World Journal of Cardiovascular Diseases, vol. 10, no. 5, pp. 319-328, 2020.
[CrossRef] [Google Scholar] [Publisher Link]
[11] Nabil Iftikhar Awan et al., “The Effect of Ejection Fraction on Mortality in Coronary Artery Bypass Grafting (CABG) Patients,” Pakistan Journal of Medical Sciences, vol. 36, no. 7, pp. 1454-1459, 2020.
[CrossRef] [Google Scholar] [Publisher Link]