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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 1, January/February 2019
58
AFRICA
pericardial tamponade. This patient died on the postoperative
sixth day despite inotropic and intra-aortic balloon pump
support. Two patients, who had undergone urgent operation
with acute coronary syndrome, were lost due to complications
of prolonged ventilation on the postoperative 25th and 54th
day, respectively. In the remaining patients, there was no
haemodynamic instability that needed long-term (
>
24 hour)
inotropic support.
A total of 59.3% of patients with acute myocardial infarction
(AMI) underwent surgery. The mean pre-operative ejection
fraction (51.3 vs 50%), number of bypass grafts (2.7 vs 3) and
length of endarterectomy (42 vs 44 mm) was similar between
patients with and without AMI. There were two deaths among
patients with AMI and one death in a patient without AMI.
Patients were discharged from hospital after postoperative 9.3
±
7.1 days with a dual antiplatelet regimen (Table 2).
Discussion
Coronary artery patients who are referred for surgery have
either multiple diseased arteries or diffuse disease. In patients
with diffuse/multisegment LAD lesions, bypass grafting of only
the distal LAD results in insufficient perfusion of the proximal
Table 1. Pre-operative demographical data of the patients
Variables
Value
Age (mean
±
SD)
60.5
±
9.7
Male,
n
(%)
42 (77.8)
Smoking,
n
(%)
31 (57.4)
Hypertension,
n
(%)
28 (51.9)
Diabetes mellitus,
n
(%)
29 (53.7)
Alcohol assumption,
n
(%)
2 (3.7)
Hyperlipidaemia,
n
(%)
27 (50)
Chronic renal failure,
n
(%)
5 (9.3)
History of AMI,
n
(%)
32 (59.3)
Atrial fibrillation,
n
(%)
6 (11.1)
NYHA classification,
n
(%)
Class 1
9 (16.7)
Class 2
44 (81.5)
Class 3
1 (1.8)
Pre-operative EF (%) (mean
±
SD)
50.9
±
6.6
AMI: acute myocardial infarction, EF: ejection fraction, NYHA: New York
Heart Association classification, SD: standard deviation.
Fig. 1.
(A) Long-segment arteriotomy of the LITA. (B) Onlay anastomosis of the LITA. (C) Bleeding control of the anastomosis. (D)
View of the anastomosis at the end of the procedure.
A
C
B
D