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Published on: March 27, 2018
Outcome of patients after coronary artery bypass grafting in cardiogenic shock
Mudassir Iqbal Dar1, Atta Ul Manan, Binish Rasheed
1Department of Cardiothoracic Surgery, Liaquat National Hospital, Karachi, Pakistan.
Insights
Coronary artery bypass graft (CABG) surgery for cardiogenic shock (CS) is high-risk but offers significant 1-year survival benefits. Early intervention improves patient outcomes and functional class, especially when other treatments are not feasible.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary artery bypass graft (CABG) surgery in patients experiencing cardiogenic shock (CS) is a rare, high-risk procedure with substantial mortality.
- Understanding outcomes for this patient cohort is critical for clinical decision-making.
Purpose of the Study:
- To review hospital outcomes and 1-year survival rates in patients undergoing CABG surgery while in CS.
- To evaluate the efficacy of early surgical intervention in high-risk cardiac patients.
Main Methods:
- A retrospective review of 13 patients who underwent CABG surgery during CS between May 2001 and April 2005.
- Analysis of 30-day mortality, patient demographics, comorbidities, and 1-year functional status.
Main Results:
- Thirty-day mortality was 16%. Patients were predominantly male (77%) with significant comorbidities including hypertension (77%), diabetes (38%), and renal impairment (31%).
- High rates of perioperative myocardial infarction (62%), poor left ventricular function (92%), and need for preoperative intra-aortic balloon pump (23%) were observed.
- One-year survival was 100% (11 patients), with 85% achieving New York Heart Association (NYHA) functional classes I to II.
Conclusions:
- CABG surgery in the setting of CS demonstrates significant 1-year survival advantages and functional class improvement.
- Early surgical intervention should be considered for patients with CS when percutaneous coronary intervention is not anatomically feasible or is contraindicated.
Purpose:
Coronary artery bypass graft (CABG) surgery in patients with cardiogenic shock (CS) is a rare and very high-risk procedure carrying high mortality. In this study we reviewed hospital outcomes and 1-year survivals in these high-risk patients.
Materials And Methods:
During a 4-year period (May 2001 to April 2005), 412 patients were operated on for CABG by a single surgeon, and 13 (3.1%) of them were in CS at the time of procedure.
Results:
The 30-day mortality of patients who underwent CABG during CS was 16%, and mean age was 57+/-10 years. A total of 77% were male, 77% were hypertensive, 38% were diabetic, and 31% had renal impairment. Myocardial infarction (MI) affected 62% within 48 h of surgery. Moderate to poor left ventricular function was found in 92%. Twenty-three percent had a preoperative intra-aortic balloon pump. Postinfract ventricular septal defect was present in 16%, and catheter-related problems were present in 23% of patients. After 1 year, all patients (11) were alive, and 85% of them were in New York Heart Association (NYHA) classes I to II.
Conclusion:
CABG in CS produces significant 1-year survival benefits and improvements in functional class. Therefore, early surgical intervention is suggested where percutaneous coronary intervention is not possible or contraindicated for anatomical reasons.
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