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Published on: March 27, 2018
The effect of ejection fraction on mortality in Coronary Artery Bypass Grafting (CABG) patients
Nabil Iftikhar Awan1, Azam Jan2, Mujeeb Ur Rehman3
1Dr. Nabil Iftikhar Awan MBBS. Post-Graduate Resident, Department of Cardiovascular & Thoracic surgery, Rehman Medical Institute, Peshawar, Pakistan.
Insights
Patients undergoing isolated coronary artery bypass grafting (CABG) with lower ejection fraction (EF) face increased mortality risks. Intra-aortic balloon pump (IABP) use also rises as pre-operative EF declines, highlighting EF
Area of Science:
- Cardiovascular Surgery
- Cardiac Physiology
- Outcomes Research
Background:
- Patients with reduced ejection fraction (EF) undergoing isolated coronary artery bypass grafting (CABG) face elevated risks of postoperative complications and mortality.
- Pre-operative EF is a critical determinant of surgical outcomes in CABG patients.
Purpose of the Study:
- To evaluate the impact of pre-operative ejection fraction (EF) on the outcomes of isolated coronary artery bypass grafting (CABG) surgery.
- To assess the relationship between EF levels and postoperative mortality and complications in CABG patients.
Main Methods:
- A cohort of 1214 patients undergoing isolated CABG between July 2017 and May 2019 were analyzed.
- Patients were stratified into three groups based on pre-operative ejection fraction: normal EF (>50%), mild to moderately reduced EF (35-50%), and severely reduced EF (<35%).
- Outcomes including intra-aortic balloon pump (IABP) use and postoperative mortality were compared across the groups.
Main Results:
- A higher proportion of patients with severely reduced EF (<35%) required intra-aortic balloon pump (IABP) support (39.0%) compared to those with normal EF (3.2%) or mild to moderately reduced EF (15.1%).
- Postoperative mortality rates increased with decreasing EF, with the severely reduced EF group exhibiting the highest mortality (8.6%) compared to normal EF (3.0%) and mild to moderately reduced EF (5.0%) groups.
- Pre-operative elevated creatinine levels were more prevalent in patients with lower EF.
Conclusions:
- Worsening pre-operative ejection fraction is significantly associated with increased postoperative mortality in patients undergoing isolated CABG.
- The need for intra-aortic balloon pump (IABP) support escalates as pre-operative left ventricular ejection fraction (LVEF) decreases.
- Pre-operative EF is a crucial prognostic indicator for isolated CABG outcomes.
Background And Objectives:
Patients with low ejection fraction undergoing isolated CABG surgery are at a higher risk for postoperative complications and mortality. This study was conducted to evaluate the impact of ejection fraction on the outcome of isolated Coronary Artery Bypass Grafting (CABG).
Methods:
Between July, 2017 to May, 2019 total 1214 patients underwent isolated CABG. Patients were divided into three groups based on their pre-operative Ejection Fraction (EF). Group-I included 625 patients with EF >50% [Normal EF], Group-II included 484 patients with EF 35-50% [Mild to Moderately Reduced EF], and Group 3 included 105 patients with EF<35% [Severely Reduced EF].
Results:
The mean age of Group-I was 57.58 ± 9.206, Group-II was 58.38±9.124 and Group-III was 58.81± 8.663. The male gender was the predominant gender in all three groups: 194(41.1%) in Group-I, 201(52.6%) in Gp2, 52 (61.9%) in Group-III. 231(36.9) patients in Group-I, 234(48.3)in Group-II and 59(56.2) in Group-III had raised creatinine pre operatively. 5(0.8%) patients in Group-I, 2(0.4%) in Group-II and 3(2.9%) in Group-III had history of CVA. Hypertension was present in approximately 60% of all our patients. In the per-operative period 20(3.2%) patients in Group-I required an IABP as compared to 73(15.1%) in Group-II and 41(39.0%) in Group-III. The mean post-operative mortality in Group-I was 19 (3%), Group-II was 24(5.0%) and low EF group was 9(8.6%).
Conclusions:
The results clearly indicate that worsening pre-operative ejection fraction is associated with a higher mortality post-operatively in patients undergoing isolated CABG. In addition, use of IABP increases as pre-operative LVEF decreases.
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