Outcome of Patients after Coronary Artery Bypass Grafting in Cardiogenic Shock

Mudassir Iqbal Dar, FRCS (C/Th), Atta Ul Manan, MBBS, Binish Rasheed, MBBS, Ghulam Murtaza, MBBS, and Mansoor Ahmad, DSc

Purpose: Coronary artery bypass graft (CABG) surgery in patients with cardiogenic shock (CS) is a rare and very high-risk procedure carrying high mortality. In this study we reviewed hospital outcomes and 1-year survivals in these high-risk patients.
Materials and Methods: During a 4-year period (May 2001 to April 2005), 412 patients were operated on for CABG by a single surgeon, and 13 (3.1%) of them were in CS at the time of procedure.
Results: The 30-day mortality of patients who underwent CABG during CS was 16%, and mean age was 57±10 years. A total of 77% were male, 77% were hypertensive, 38% were diabetic, and 31% had renal impairment. Myocardial infarction (MI) affected 62% within 48 h of surgery. Moderate to poor left ventricular function was found in 92%. Twenty-three percent had a preoperative intra-aortic balloon pump. Postinfract ventricular septal defect was present in 16%, and catheter-related problems were present in 23% of patients. After 1 year, all patients (11) were alive, and 85% of them were in New York Heart Association (NYHA) classes I to II.
Conclusion: CABG in CS produces significant 1-year survival benefits and improvements in functional class. Therefore, early surgical intervention is suggested where percutaneous coronary intervention is not possible or contraindicated for anatomical reasons. (Ann Thorac Cardiovasc Surg 2007; 13: 247-250)

Key words: coronary artery bypass graft, cardiogenic shock, survival

Department of Cardiothoracic Surgery, Liaquat National Hospital, Karachi, Pakistan

Received July 10, 2006; accepted for publication November 13, 2006
Address reprint requests to Mudassir Iqbal Dar: Asst. Professor Cardiac Surgery, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, Post code 74200, Pakistan.