Impact of Pre-, Intra-and Post-Operative Parameters on In-Hospital Mortality in Patients Undergoing Emergency Coronary Artery Bypass Grafting: A Scarce Single-Center Experience in Resource-Scare Setting

Abstract

Background: In-hospital mortality after emergency coronary artery bypass grafting (CABG) remains an important issue that has needed considerable attention in recent years as the mortality rate is still high and prevention factors are not yet optimal. Our study presents the first largest cohort of emergency CABG from one large institution in Vietnam with the primary aim of comparing a large variety of pre-, intra-and postoperative parameters between in-hospital mortality patients and in-hospital survival patients and investigate risk factors of in-hospital mortality in patients undergoing emergency CABG. Methods: We conducted a retrospective evaluation of prospectively collected data in patients undergoing emergency CABG at the Hanoi Heart Hospital (Hanoi, Vietnam) from January 1, 2017, to December 31, 2019. Primary outcome variable was in-hospital mortality. Results: A total of 71 patients were included in final analysis. The mean age of the cohort was 68.68 years (± 9.28, range 38-86). The mean weight, height and body mass index were 54.35 kg (± 9.17, range 37-77), 158.96 (±7.64, range 145-179) and 21.48 kg/m 2 (±3.08, range 13.59-30.08), respectively. In-hospital mortality rate was 9.86%. Preoperative risk factors for in-hospital mortality included diabetes, decreased ejection fraction (EF), EF below 30%, cardiogenic shock, elevated systolic pulmonary artery pressure (PAP), elevated NT-ProBNP, and Euroscore II. Without grafting with left internal thoracic artery, and prolonged cardiopulmonary bypass (CPB) time were increased intraoperative factors for inhospital mortality risk. In-hospital mortality's postoperative risk factors were found to be postextubation respiratory failure requiring mechanical ventilation, ventricular fibrillation, dialysis-requiring acute renal failure, pneumonia, bacterial sepsis, gastrointestinal bleeding, and prolonged mechanical ventilation time. Significant predictors determining in-hospital mortality were known as prolonged CPB time in surgery and postoperative ventricular fibrillation. Conclusion:Our hospital mortality rate after emergency CABG was relatively high. An optimal preventive strategy in emergency CABG management should target significant factors combined with other previously identified risk factors to reduce in-hospital mortality.

Pre-operative, Intraoperative, and Post-operative Determinants Associated with 30-day Mortality Post-Coronary Artery Bypass Graft: A Retrospective Cohort Study

“…The 30 day-mortality rate of CABG patients in this study was 11.8% which is higher than the study conducted by Hung et al with mortality rate of 9.8% [9]. It is also higher overall mortality rate as compared to other 30-day mortality rate as reported by Adelborg et al with 3.2% mortality rate and 2.44% reported by Hansen et al [10], [11].…”

“…This study had a limitation. First, the 95% confidence interval hazard ratio results of this study have a relatively wide range; however, it is not as wide as the study by Hung et al [9]. While the wide range of confidence interval could be attributed to the small number of samples used in this study, however, the authors deemed the result as relevant.…”

Evaluation of Complications Predictors in the Performance of Coronary Artery Bypass Grafting Surgery in the Cardiac Surgery Clinic "Bicard"

“…Our data is supported also by researches of other authors. [14][15][16] The risk of complications development in case of CABG increases if the AIM has been presented in anamnesis, an intraoperative connection of intra-aortic balloon counterpulsation has been conducted; the artificial circulation has been used for more than 120 min, and aortic compression has been introduced for more than 90 min. 12 We have got data opposite 17 to the one declared by Nadeem et al and Ortiz et al that length of the artifi cial circulation period and aortic compression time are the predictors of postoperative complications development in cardiac surgical patients.…”

Association of Vasoactive-Inotropic Score with Postoperative Outcomes in Children with Congenital Heart Diseases Undergoing Cardiac Surgery

“…4,5 One common complication seen in children undergoing CHD surgery is low cardiac output syndrome, necessitating postoperative administration of inotropic support. [6][7][8] The Wernovsky scoring system and its variations have been utilized to quantify the pharmacologic cardiovascular support required in the postoperative period. [9][10][11][12] However, the specific role of the vasoactive inotropic score (VIS) in predicting postoperative outcomes in the context of CHD surgeries remains relatively unexplored, particularly www.pakheartjournal.com in regions like Pakistan, where access to specialized pediatric cardiac care may be limited.…”