Predictors of mortality in patients with left ventricular failure [abstract]

We retrospectively reviewed the clinical presentation and five-year mortality of 64 consecutive adults who underwent echocardiography at the Eric Williams Medical Sciences Complex between January 1992 and December 1994 with a left ventricular ejection fraction < 40 percent. The mean age was 60ñ12 years and 68 percent of patients were male. The prevalence of diabetes mellitus and hypertension was 40 percent and 46 percent, respectively. The mean left ventricle ejection fraction was 30ñ9 percent. The most common primary cost of left ventricular failure was coronary artery disease (CAD) in 47 percent, idiopathic dilated cardiomyopathy (9 percent), hypertensive heart disease (9 percent), alcohol related dilated cardiomyopathy (8 percent) and valvular heart disease (6 percent). Angiotensin converting enzyme inhibitors were prescribed in 85 percent of cases, diuretics (82 percent), digoxin (61 percent), warfarin (18 percent), beta blockers (10 percent), and amiodarone (8 percent). Survival data were available for 84 percent. Mortality was 53 percent at 5 years. Independent predictors of mortality were age, the use of beta blockers and left ventricular internal diameter. In conclusion, CAD was the most common cause of left ventricular failure. Five-year mortality was high, particularly in elderly patients with marked ventricular dilatation. (AU)

Coronary artery bypass graft outcome: the Trinidad and Tobago experience

The study is a retrospective review of the demographic, clinical, angiographic, and operative data of the first 205 consecutive CABG operations performed by Caribbean Heart Care at the Eric Williams Medical Sciences Complex (EWMSC), Trinidad and Tobago, between November 1993 and December 1997. The aim of the study was to determine the in hospital and intermediate term follow up results. The mean age of patients was 59 ñ 10 years and 78 percent male. Sixty-four percent were of East Indian descent, whereas, 16 percnt were of Africian descent. Forty-eight percent of the patients were hypertensive, 46 percent were diabetic, 33 percent had hyperlipidaemia, 20 percent had a recent history of cigarette smoking and 16 percent were obese. Sixty-five percent had a positive family history of ischaemic heart disease. The average time interval between angiography and surgery was 2.3 months. At the time of angiography, 63.5 percent of patients had Canadian Cardiac Society (CCS) class 3 or 4 angina. The mean ejection fraction was 61 ñ 15 percent. Wall motion abnormalities were seen in 67 pecent of patients. Significant stenoses of the left anterior descending artery, right circumflex artery, circumflex and ramus coronary arteries were present in 91 percent, 78 percent, 54 percent and 5 percent, respectively. Many patients (67 percent) had severe diffuse disease on angiography. The mean intensive care stay was 2.2 ñ 0.8 days. In hospital mortality was 3.9 percent (8/205). THe most frequent post operative complicaton was haemorrhage (2.6 percent). Acute renal failure occurred in 2.1 percent; pulmonary collapse, 1.6 percent; 1 percent and cardiac arrest , 1 percent. Both sternal wound infections and systemic sepsis occurred in 0.5 percent. Intermediate term follow-up data were obtained for 92 percent (189/205). The duration of follow-up ranged from 1 to 5 years (mean 3.7 years). During the follow up period, 7 patients (3.4 percent) died. Angina severity was reduced from a mean CCS score of 2.61 ñ 0.95 before CABG ot 1.22 ñ 0.55 at the time of follow up (p<0.0001). Overall 4-year mortality compared favourably with data from international studies. Among survivors, quality of life improved as evidenced by the reduction in the mean angina score.(Au)

The feasibility of a porcine model of acute coronary occlusion and reperfusion using off-pump coronary artery bypass grafting

We developed an open-chest porcine model of acute coronary occlusion and surgical reperfusion, and attempted to prevent intra-operative ischaemic ventricular fibrillation (VF) by a Retrograde Intracoronary Glyceryl trinitrate (RIG) infusion into the occluded vessel. Five Yorkshire pigs (weight 50ñ 1.1kg), randomized into 3 groups, underwent median sternotomy under general anaesthesia. One pig (Group 1, control) underwent sternotomy and pericardiotomy only. Four pigs underwent acute left anterior descending (LAD) coronary occlusion. Two pigs were not reperfused (Group 2). Two pigs underwent surgical reperfusion (Group 3) via left internal mammary artery (LIMA) grafting to the LAD using the Off-Pump Coronary Artery Bypass (OPCAB) technique. Ischaemic injury was assessed using 7-lead electrocardiography (EGG) and transthoracic/epimyocardial echocardiography (ECHO). Group 1: transient intraoperative hypotension and VF occurred. Successful resuscitation and 10-week survival (until sacrifice) with normal left ventricular (LV) function was achieved. Group 2: there were ECG and ECHO evidence of acute LV ischaemic dysfunction in both pigs. The surviving pig had persistent anterior hypokinesis at 8« months. The other died intra-operatively following progressive ischaemic LV dysfunction despite resuscitative attempts. Group 3: the surving pig had normal LV function at 8 months. Initial anterior LV akinesis normalized within 7 days. The other developed post-occlusion haemodynamic instability and died intra-operatively despite reperfusion. In this porcine model, acute LAD artery occlusion modified by the novel RIG infusion technique, followed by surgical reperfusion (OPCAB) is feasible. This model would facilitate further development of OPCAB surgical expertise and understanding of the pathophysiology of ischaemia-reperfusion injury.(Au)

Coronary artery bypass surgery in Trinidad: morbidity and mortality - Poster abstract

OBJECTIVE: To determine whether Coronary artery bypass grafting (CABG) in Trinidad influenced morbidity and mortality. METHOD: Retrospective review of the demographic, clinical and angiographic data of the first 205 consecutive CABG operations performed by Caribbean Heart Care at the Eric Williams Medical Sciences Complex, Trinidad, between November 1993 and December 1997. RESULTS: The mean age was 59 ñ 10 years and 74 percent were males. The average time interval between angiography and surgery was 2.3 months. At the time of angiography, 69 percent of patients had class 3 or 4 angina (CCS). The mean ejection fraction was 63 ñ 13 percent. Many patients (64 percent) had severe diffuse disease on angiography. The in-hospital mortality was 8/205 (3.9 percent). Follow-up data were obtained for 189/205 (92 percent). The duration of follow-up ranged from 1 to 5 years. During the follow-up period, 7/189 patients. (3.4 percent) died. Angina severity before and after surgery was determined in 174 surviving patients. Angina severity was reduced from a mean CCS score of 2.61 ñ 0.95 before CABG to 1.22 ñ 0.55 after CABG (p<0.0001). CONCLUSION: Overal 4-year mortality compared favourably with data from international studies. Amongst survivors, quality of life improved as evidenced by the reduction in the mean angina score.(AU)