Protocolo de Manejo Perioperatorio de la Miocardiopatía Isquémica en un Hospital Comunitario

We describe our experience using a defined protocol for the selection, classification, and treatment of patients with ischemic cardiomyopathy (ICM) undergoing coronary artery bypass grafting (CABG), with or without additional procedures, in a nonacademic setting with expected limited resources and support staff.

From December 2021 to December 2023, 25 patients with an ejection fraction of ≤0.44 due to ICM requiring CABG were assigned to a treatment algorithm based on the preoperative classification for CABG with no device (n = 9), balloon pump (n = 2), or direct centrifugal pump (n = 14) placed in the operating room.

Preliminary data of all patients with surgically revascularized ICM using the defined protocol demonstrated a predicted average risk of mortality of 8.455% vs our mortality rate of 4%, whereas the average predicted risk of morbidity and mortality was 27.7%, with our 30-day morbidity and mortality of 24%. Subgroup analysis of the 3 patient categories: moderately depressed, low risk; moderately depressed, high risk; and severely depressed; shows better-than-expected outcomes when compared with predictions.

In a community hospital setting, experience using a defined protocol to select and manage patients with ICM undergoing CABG reduced morbidity and mortality compared with predicted outcomes. This is a practical method of managing high-risk CABG patients with the expected limitations of a community hospital.