Review of current status of cardiovascular and thoracic surgery in Nepal: An analysis from collection of institutional database.

OBJECTIVE: Data collected from various institutions around the country was analyzed to assess the current status of cardiovascular and thoracic surgery in the country. METHODS: We collected data from institutions performing cardiovascular and thoracic surgery from all over the country through direct correspondence for the year 2019. Individual institution data on the number of surgeries performed for cardiac, vascular, and thoracic surgery and its outcome in terms of mortality were compiled. The data were further evaluated depending on the type of procedures performed. RESULTS: Overall, a total of 2264 cardiac surgeries were performed in the country in the year 2019. The majority of the surgeries were for valvular heart surgery accounting for 34.3%, followed by congenital surgeries (32.8%) and surgeries for coronary artery disease (25.9%). A total of 649 thoracic surgeries were documented, which is probably marginally less than the actual numbers because we were unable to include an additional few institutions performing low-volume or isolated thoracic procedures in this report. A total of 852 vascular procedures were performed in the country, which is probably underreported. The mortality rates for complex congenital procedures were higher than those reported in the literature and that of adult procedures such as valvular heart disease and coronary artery disease similar to literature. CONCLUSION: We evaluated the recent status of cardiovascular and thoracic surgery in the country with respect to the type of procedures and the postoperative outcomes.

Coronary Artery Bypass Grafting Following COVID-19 Infection: Difficulties and Challenges.

The COVID-19 pandemic has raised challenges and dilemmas to perform cardiac surgery in the patients following COVID-19 infection due to lasting adverse impacts of the disease on the lungs. A 74-years-old patient, recently infected by COVID-19, with previous myocardial infarction and multiple percutaneous coronary interventions, in-stent thrombosis to the left anterior descending artery, and low resting saturation, presented with chest pain and underwent urgent coronary artery bypass grafting. His postoperative period remained challenging due to high oxygen requirements. He had otherwise an uneventful recovery and was discharged on domiciliary oxygen, which was weaned off over three months and he continues to do well at six months of follow-up. Keywords: Cardiac surgery; COVID-19; coronary artery bypass surgery; pandemic.

Role of pre-operative red cell distribution width estimation in the prediction of in-hospital mortality after off-pump coronary artery bypass grafting.

BACKGROUND: Red cell distribution width (RDW) level is routinely provided in a simple and inexpensive complete blood count report. However, RDW is sometimes overlooked. Recently a higher RDW level is found associated with postoperative mortality after off-pump coronary artery bypass. Many risk-prediction tools are available, like the European System for Cardiac Operative Risk Evaluation, Society of Thoracic Surgeons score, etc. but all need improvement for better prediction. So, a new risk-factor should be discovered which is simple enough for clinical use and cost-effective, and improves the risk assessment tools that help to predict and avoid preventable mortality following cardiac surgery. METHODS: The prospective study was conducted, taking a total of 150 patients of coronary artery disease who underwent elective isolated off-pump coronary artery bypass. The study population was grouped according to their preoperative RDW level as Group A (RDW ≤ 14%), Group B (RDW 14-16%), and Group C (RDW ≥ 16%). The receiver operating characteristic (ROC) curve was constructed and multivariate regression analysis was done to see the predictive value of RDW for in-hospital mortality. RESULTS: The mortality rate was 2.7%, N = 150. ROC curve revealed Area Under the Curve 0.841 and p = 0.020 that indicates the RDW as the reliable predictor for in-hospital mortality. Multivariate regression analysis showed the RDW to be the only variable independently predicting in-hospital mortality after off-pump coronary artery bypass among possible haematological predictors. (OR 1.838, 95% CI 1.061-3.186, p = 0.030). CONCLUSION: Preoperative raised RDW level is a novel predictor of in-hospital mortality after off-pump coronary artery bypass. Further studies should be done to determine the associated mechanism.