CLINICAL OUTCOME OF CABG IN EGYPTIAN SEPTUAGENARIAN POPULATION

Abstract

Background: CABG is one of the most common surgical procedures performed worldwide. The operation improves survival as well as the quality of life of patients with coronary artery heart disease. The use of the internal mammary artery (IMA) graft has become increasingly popular in CABG operations due to its demonstrated better long-term patency as compared with that of the saphenous vein graft. Aim of the Work: To determine the clinical outcome of GABG in Egyptian Septuagenarian population and to identify risk factors that may adversely affect morbidities and mortality. Patients and Methods: This nonrandomized, comparative, and prospective with propensity score matching study was conducted in department of cardiothoracic surgery Nasser Institute Hospital (NIH) and Department of cardiothoracic surgery Ain Shams University (ASU on 100 patients diagnosed to coronary artery diseases divided into 2 groups according to their age at time of operation either patient aged 70 years to 79 years or patient less than 70 years. Results: Current study results showed that there was statistically significant increase in the percentage of patients with arrhythmia, low cardiac output, reoperation, neurological complications, pulmonary complications, mediastinitis and rewiring and renal impairment in died patients than alive patients. Also, the percentage of total morbidity was found higher in died patients than alive patients. The median mechanical ventilation hours, stay on ITU hours and nights was found higher in died patients than alive patients while no statistically significant relation found between total hospital stay and mortality among patients of group B. Also, the percentage of patients with poor ejection fraction post discharge was found higher in died patients than alive patients with p-value <0.001. Conclusion: Advanced age impacts surgical outcomes after CABG with Septuagenarians having worse postoperative outcomes including higher complications and mortality than younger cases. Additionally, in Septuagenarians, females had a higher mortality than their male counterparts did. An explanation for the worse outcome in the female group is most likely multifactorial and requires additional explanation. Taken together, our results demonstrate that a careful assessment of older patients must take place to determine the best management strategy to provide coronary revascularization, we recommend versal study for more accurate analysis of the regional blood flow supply to the papillary muscle system, mitral valve and mitral apparatus by Cardiac MRI.