Background: Vigilance ensures safety in
cardiac surgery. Performance in cardiac
surgery is often measured by short-term mortality. Several
risk factors like advanced age, female gender, higher body mass index,
decreased left ventricular function, emergent, and redo operations have
appeared recurrently as poor prognostic variables. Evaluation of postoperative
mortality is crucial to find loopholes to provide proper care and reduce
preventable mortality after cardiac surgery in developing countries with
limited infrastructures and resources. Methods: This is a retrospective
study conducted in the Department of Cardiac
Surgery, Bangabandhu Sheikh Mujib Medical University. Perioperative data
of 100 cases of mortality after cardiac surgery performed from 1 January 2014 to 30 May 2018 were collected from
the university medical record. The
data on age, gender, body mass index, preoperative investigations, diagnoses,
types of operations, details of cardiopulmonary bypass, and postoperative
period of the study populations were evaluated. Results: During the
study period, about 1627 cases of cardiac surgery were done with an overall
mortality rate of 6.15%. The mean age was 41.05 ± 20.19 (0 - 68) years, and 66% of patients were male. Preoperative ejection
fraction (EF) of the study population
was an average 56.63% ± 11.85%; 9% of the patients had EF < 40%. Off-pump
coronary artery bypass (32.27%) was the most commonly performed surgery
followed by mitral valve replacement (24.28%). On-pump cardiac surgery
was done among 65% of the study population with a mean cross-clamp time and
bypass time of 32.56 ± 11.55 minutes and 80.57 ± 18.09 minutes, respectively. Most
of the mortality was found in the first two weeks after sur
References
[1]
Siregar, S., Groenwold, R.H., de Mol, B.A., Speekenbrink, R.G., Versteegh, M.I., Brandon Bravo Bruinsma, G.J., Bots, M.L., van der Graaf, Y. and van Herwerden, L.A. (2013) Evaluation of Cardiac Surgery Mortality Rates: 30-Day Mortality or Longer Follow-Up? European Journal of Cardio-Thoracic Surgery, 44, 875-883. https://doi.org/10.1093/ejcts/ezt119
[2]
Omar, R.Z., Ambler, G., Royston, P., Eliahoo, J. and Taylor, K.M. (2004) Cardiac Surgery Risk Modeling for Mortality: A Review of Current Practice and Suggestions for Improvement. The Annals of Thoracic Surgery, 77, 2232-2237. https://doi.org/10.1016/j.athoracsur.2003.10.032
[3]
Pons, J.M., Espinas, J.A., Borras, J.M., Moreno, V., Martin, I. and Granados, A. (1998) Cardiac Surgical Mortality: Comparison among Different Additive Risk-Scoring Models in a Multicenter Sample. Archives of Surgery, 133, 1053-1057. https://doi.org/10.1001/archsurg.133.10.1053
[4]
Kaplan, J.A. (2008) Essentials of Cardiac Anesthesia. Saunders, Philadelphia, 7.
[5]
Shannon, F.L., Fazzalari, F.L., Theurer, P.F., Bell, G.F., Sutcliffe, K.M. and Prager, R.L., Michigan Society of Thoracic and Cardiovascular Surgeons (2012) A Method to Evaluate Cardiac Surgery Mortality: Phase of Care Mortality Analysis. The Annals of Thoracic Surgery, 93, 36-43. https://doi.org/10.1016/j.athoracsur.2011.07.057
[6]
Nowicki, E.R., Birkmeyer, N.J., Weintraub, R.W., Leavitt, B.J., Sanders, J.H., Dacey, L.J., Clough, R.A., Quinn, R.D., Charlesworth, D.C., Sisto, D.A. and Uhlig, P.N. (2004) Multivariable Prediction of In-Hospital Mortality Associated with Aortic and Mitral Valve Surgery in Northern New England. The Annals of Thoracic Surgery, 77, 1966-1977. https://doi.org/10.1016/j.athoracsur.2003.12.035
[7]
Kamal, Y.A., Al-Elwany, S., Ghoneim, A. and El-Minshawy, A. (2017) Traditional Predictors of In-Hospital Mortality after Coronary Artery Bypass Grafting: Current Status. Cardiothoracic and Vascular Science, 1, 1-5. https://doi.org/10.15761/CVS.1000107
[8]
Nashef, S.A., Roques, F., Sharples, L.D., Nilsson, J., Smith, C., Goldstone, A.R. and Lockowandt, U. (2012) EuroSCORE II. European Journal of Cardio-Thoracic Surgery, 41, 734-745. https://doi.org/10.1093/ejcts/ezs043
[9]
Rao, G.H.R. (2005) Coronary Artery Disease: Risk Factors, Pathophysiology and Prevention. Jaypee Medical Publishers, New Delhi, India, 21-57.
[10]
Ranjan, R., Joshi, D., Ullah, M.A., Bajracharya, P., Saha, S. and Adhikary, A.B. (2019) A 50-Year-Old Female, Diabetic Patient with Chest Pain and Dizziness. Bangabandhu Sheikh Mujib Medical University Journal, 12, 187-191. https://doi.org/10.3329/bsmmuj.v12i4.44274
[11]
Yusuf, S., Hawken, S., Ôunpuu, S., Dans, T., Avezum, A., Lanas, F., McQueen, M., Budaj, A., Pais, P., Varigos, J. and Lisheng, L. (2004) Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction in 52 Countries (the INTER- HEART Study): Case-Control Study. The lancet, 364, 937-952. https://doi.org/10.1016/S0140-6736(04)17018-9
[12]
Hammermeister, K.E., Burchfiel, C., Johnson, R. and Grover, F.L. (1990) Identification of Patients at Greatest Risk for Developing Major Complications at Cardiac Surgery. Circulation, 82, IV380-389. PMID: 2225429
[13]
Hossain, M.A., Vaidya, S., Acharya, M., Joshi, D., Sunny, S.A. and Khan, O.S. (2019) Atypical Location of an Atrial Myxoma: A Case Report. Mymensingh Medical Journal: MMJ, 28, 705-707. PMID: 31391449
[14]
Oskvig, R.M. (1999) Special Problems in the Elderly. Chest, 115, 158S-164S. https://doi.org/10.1378/chest.115.suppl_2.158S
[15]
Gupta, M., Brister, S. and Verma, S. (2006) Is South Asian Ethnicity an Independent Cardiovascular Risk Factor? Canadian Journal of Cardiology, 22, 193-197. https://doi.org/10.1016/S0828-282X(06)70895-9
[16]
Desborough, J.P. (2000) The Stress Response to Trauma and Surgery. British Journal of Anaesthesia, 85, 109-117. https://doi.org/10.1093/bja/85.1.109
[17]
Ri, M., Aikou, S. and Seto, Y. (2018) Obesity as a Surgical Risk Factor. Annals of Gastroenterological Surgery, 2, 13-21. https://doi.org/10.1002/ags3.12049
[18]
Lappé, J.M., Horne, B.D., Shah, S.H., May, H.T., Muhlestein, J.B., Lappé, D.L., Kfoury, A.G., Carlquist, J.F., Budge, D., Alharethi, R. and Bair, T.L. (2011) Red Cell Distribution Width, C-Reactive Protein, the Complete Blood Count, and Mortality in Patients with Coronary Disease and a Normal Comparison Population. Clinica Chimica Acta, 412, 2094-2099. https://doi.org/10.1016/j.cca.2011.07.018
