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Review Article | DOI: https://doi.org/10.31579/2693-2156/057
*Corresponding Author: Mohammed Habib, Alshifa Hospital, Cardiology Department. Gaza.
Citation: Mohammed Habib, Abdelaziz abu Samara, (2023), Evaluation of Major Adverse Cardiac Events After Cardiac Surgery in Gaza, J Thoracic Disease and Cardiothoracic Surgery, 2(1); DOI:10.31579/2693-2156/057
Copyright: © 2023, Mohammed Habib. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 01 May 2023 | Accepted: 07 May 2023 | Published: 19 May 2023
Keywords: Cardiac, Cardiac Surgery, Gaza
The present study assessed the major adverse cardiac events (MACE) (hospital mortality rate, major stroke and reintervention) after cardiac surgery du to coronary artery bypass grafting or valve surgery or both in the Ministry of health hospitals (MOH) in Gaza Strip at 2022 by either Local or Expert cardiac surgery team.
Cardiovascular disease (CVD) is the leading cause of death in the world, accounting for approximately 17.5 million deaths worldwide every year, of which 80% occur in low- and middle-income countries. Coronary artery bypass grafting (CABG) has remained the most commonly performed cardiac surgery procedure for coronary artery disease over the past decades [1]. The main goal of the surgery is to improve survival and health related quality of life (QoL) [2]. Despite the fact that the profile of patients undergoing isolated CABG surgery has changed towards higher age with increased frequency of preoperative comorbidities [3,4]. mortality rate and morbidity after CABG have even decreased over past decades in the world [5].
The purpose of the present study was to compare hospital mortality rates of patients seen in the MOH health system who underwent coronary bypass surgery or valve surgery for the first time in publicly hospitals by local or foreign cardiac surgeon at MOH hospitals during 2022.
Methods
Retrospective cohort study including all patients who underwent cardiac surgery by local or expert cardiac surgery team with cardiopulmonary bypass and /or valve surgery in the MOH hospitals at Gaza Strip during 2022.
Data Collection
From 1th January 2022 to 31th December 2022, data were prospectively collected for all patients covered by the public healthcare system in whom a coronary artery bypass graft (CABG) and/or cardiac valve surgery was indicated as first surgery. This was done at two publicly managed hospitals (Alshifa and European Gaza Hospital)
Type of Surgery
First time coronary artery bypass graft (CABG) and/or cardiac valve surgery
End Points (MACE)
Hospital mortality: was defined as death due to any cause during or after the procedure and up to hospital discharge, or within 30 days following the procedure.
Reintervention: The event was defined as the first reintervention for acute coronary syndrome after cardiac surgery. This reintervention could be a cardiological intervention such as a PCI or similar procedure on a cardiosurgical intervention such as isolated or combined CABG, mitral valve repair or replacement for ischemic valve disease within 90 days
Major stroke: patients with permanent Disability and NIHSS (National Institute of Health Stroke Scale) NIHSS more than 15 and Modified Rankin Scale mRS >2 within 30 days
Expert cardiac surgeon: working total operation at least > 1000 cases and empierce > 10 years after graduated, we have 3 expert cardiac surgeon 2 from USA and one from Germany who make operation as short period in MOH in Gaza.
Statistical analysis
Baseline variables Continuous data are reported as means ± SD. Categorical data are presented as absolute values and percentages. Using the x2 test for calculation of MACE (mortality rate, major stroke and reintervention) between patients underwent cardiac surgery local and expert cardiac surgeon. Significance level was set at P value < 0>
Results
Among the 98 patients (27 female and 72 male) with mean age 56±12 years scheduled for surgery during the study period, 38 patients was operated by local team, and 60 patients was operated by expert cardiac surgeon during 2022 in Gaza MOH hospitals. (table 1) Total Patients
| 98 |
| Mean age 56+12 years |
| Male 72 (73.5%) |
| Risk factors: |
| Hypertension 62 (63%) |
| Diabetes mellitus 43 (43.9%) |
| Type of Surgery: |
| CABG 74 (74%) |
| Valve surgery 22 (22%) |
| Combination (CABG + valve) 2 (2%) |
| End Points: |
| Death 6 (6%) |
| Reintervention 5 (5%) |
| Major stroke 2 (2%) |
Table 1: characterizes of patients
The comparison of end points (mortality, major stroke and reintervention) between local and expert cardiac surgeons, was significantly low in patients operated by expert surgeon (table2)
| Local (38) expert (60) p value |
| End points 9 4 0;015 |
| Mortality 3 3 |
| Major stroke 1 1 |
| Re-intervention 5 0 |
Table 2: The comparison of MACE
The major causes or reintervention (incomplete revascularization in three patients , severe stenosis at anastomosis area in one patient, wrong anastomosis in one patient)
Discussion
The Gaza strip need 350-400 case for coronary artery bypass grafting and 200-250 for cardiac valve surgery yearly[6].
Because the restricted siege of Gaza from 2006 until now. Cardiac surgery was started in Gaza at 2010 by visitor cardiac surgeon from USA and Germany for making and educated local team, but the 30 days mortality in patients who operated by local cardiac surgeon still high 8% (three patients from 38 patients) and reintervention within 3 months is high 13
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