Tabula viva chirurgi: a living surgical document

Swart, Marius; Joubert, Gina; Berg, Jan-Albert van den; Zyl, G J van

doi:10.5830/cvja-2015-081

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…A review of 17,335 CABG surgeries performed in Spain between 2013 and 2015 demonstrated a crude mortality rate of 5% [ 12 ]. Similarly, Swart et al analysed outcomes post CABG in a South African cardio-thoracic private practice and reported a mortality rate of 3% [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

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

Reiche

Mpanya

Vanderdonck

et al. 2021

J Cardiothorac Surg

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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.

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Section: Discussionmentioning

confidence: 99%

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

Reiche

Mpanya

Vanderdonck

et al. 2021

J Cardiothorac Surg

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“…(12) Low homologous red blood cell consumption in this practice has been reported previously. (17) Lactate is the conjugate base after lactic acid has lost a proton. This is the result of glucose and pyruvate metabolism in a hypoxic environment, but also when there is hypoperfusion of the liver as during CPB.…”

Section: Minimal Extracorporeal Circulationmentioning

confidence: 99%

Minimal extracorporeal circulation: An appraisal from a private practice

Swart¹,

Joubert²

2019

SAHJ

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INTRODUCTION Cardiopulmonary bypass (CPB) and cardiac arrest allow the surgeon to perform controlled anastomoses during coronary artery bypass graft surgery (CABG). However, this comes at a cost. A systemic inflammatory response is a risk for organ damage and thus mortality and morbidity. Beating heart surgery, or off-pump CABG (OPCAB), was reintroduced to attenuate this effect. Many studies demonstrated very optimistic results in favour of OPCAB compared to CABG with conventional CPB. However, not everybody is convinced by the benefits, and this was addressed in a review on whether it would be beneficial to change to OPCAB. (1) In this study, the combined prevalence of mortality, myocardial infarction, stroke and new dialysis was 4%. To improve this with even 25% would require 10 600 patients, which is impossible in the average private cardiac practice in South Africa. Many randomised controlled studies could not demonstrate clear benefits and surgeons are losing interest in the OPCAB technique. (2) This is confirmed by a review from the Cochrane Libraries. Based on the current evidence, CABG should be done with conventional CPB. (3)

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Outcomes of Coronary Artery Bypass Graft Surgery in Africa: A Systematic Review and Meta-Analysis

Akintoye,

Fasina,

Adiat

et al. 2023

Cureus

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Coronary artery bypass graft (CABG) surgery has been in practice for many decades, and it is one of the most commonly performed cardiac surgeries worldwide. While there are several studies reporting data on perioperative outcomes following CABG in developed countries, there is a staggering paucity of data and evidence reporting the outcomes in developing areas such as Africa. Thus, it is important to study the practice and outcome of CABG in Africa to establish its clinical efficacy and safety in this region and identify factors that might be limiting its practice. The overall aim of this study is to identify all relevant clinical data on CABG in Africa and report on the perioperative outcomes and practice of CABG in the African population. Electronic search was performed using three online databases, PubMed, African Journal Online, and Research Gate, from inception to June 2023. The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline was utilised for this study. Relevant studies fulfilling predefined eligibility criteria were included in the study. Intraoperative details, such as the number of grafts performed, operative, bypass, and cross-clamp time, were reported. The primary endpoint assessed were early mortality and overall mortality. The secondary endpoints included length of hospital stay, intensive care unit stay, and postoperative complications, such as renal impairment, atrial fibrillation, and surgical site infection. The data were pooled together and meta-analyzed using a random effect model for proportions and mean for meta-analysis with R software (version 4.3.1 (2023-06-16); R Development Core Team, Vienna, Austria). This systematic review identified 42 studies that fulfilled the study eligibility criteria, including 21 randomised controlled trials, 20 observational studies, and one cross-sectional study. Only four out of the 54 countries in Africa had studies carried out that met the criteria for this review; they included Algeria, Egypt, Nigeria, and South Africa, with a majority from Egypt. Meta-analysis reported a pooled early mortality and pooled overall mortality of 3.51% and 3.73%, respectively, for the total cohort of patients. The result of this meta-analysis suggests that mortality outcomes following CABG in Africa are relatively higher than those in developed nations. Several issues, such as lack of financial resources and poor infrastructure, continue to hinder the optimal practice of CABG procedures in many parts of Africa. Further studies focused on finding factors associated with outcomes following CABG should be done. Though there were a few limitations to the study largely from a lack of data from several regions and countries in Africa, the result from this meta-analysis can serve as a benchmark for future studies until more relevant data are reported.

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Tabula viva chirurgi: a living surgical document

Cited by 3 publications

References 30 publications

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

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

Minimal extracorporeal circulation: An appraisal from a private practice

Outcomes of Coronary Artery Bypass Graft Surgery in Africa: A Systematic Review and Meta-Analysis

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