Awan Nabil Iftikhar, Jan Azam, Rehman Mujeeb Ur, Ayaz Narmeen
Dr. Nabil Iftikhar Awan MBBS. Post-Graduate Resident, Department of Cardiovascular & Thoracic surgery, Rehman Medical Institute, Peshawar, Pakistan.
Dr. Azam Jan, ABTS. Head of Department, Department of Cardiovascular & Thoracic surgery, Rehman Medical Institute, Peshawar, Pakistan.
Pak J Med Sci. 2020 Nov-Dec;36(7):1454-1459. doi: 10.12669/pjms.36.7.3266.
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).
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].
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%).
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.
接受单纯冠状动脉旁路移植术（CABG）的射血分数降低患者术后并发症和死亡风险更高。本研究旨在评估射血分数对单纯冠状动脉旁路移植术（CABG）结局的影响。
2017年7月至2019年5月期间，共有1214例患者接受了单纯CABG手术。根据术前射血分数（EF）将患者分为三组。第一组包括625例EF>50%的患者[正常EF]，第二组包括484例EF为35 - 50%的患者[轻度至中度降低EF]，第三组包括105例EF<35%的患者[严重降低EF]。
第一组的平均年龄为57.58±9.206，第二组为58.38±9.124，第三组为58.81±8.663。男性在所有三组中均占主导：第一组194例（41.1%），第二组201例（52.6%），第三组52例（61.9%）。第一组231例（36.9%）、第二组234例（48.3%）和第三组59例（56.2%）患者术前肌酐升高。第一组5例（0.8%）、第二组2例（0.4%）和第三组3例（2.9%）患者有脑血管意外病史。约60%的患者患有高血压。在围手术期，第一组20例（3.2%）患者需要主动脉内球囊反搏（IABP），而第二组为73例（15.1%），第三组为41例（39.0%）。第一组术后平均死亡率为19例（3%），第二组为24例（5.0%），低EF组为9例（8.6%）。
结果清楚地表明，接受单纯CABG手术的患者术前射血分数恶化与术后较高的死亡率相关。此外，随着术前左心室射血分数（LVEF）降低，IABP的使用增加。
