TITLE:
Coronary Artery Bypass Surgery for Patients Presenting with Ventricular Arrhythmias: Propensity Matched Early and Late Outcome
AUTHORS:
Ahmed M. Habib, Azar Hussain, Martin Jarvis, Alexander Cale, Michael Cowen, Dumbor Ngaage, Mubarak Chaudhry, Mahmoud Loubani
KEYWORDS:
Ischemic Ventricular Arrhythmia (IVA), Ventricular Fibrillation (VF), Implantable Cardioverter (ICD), Coronary Artery Disease (CAD)
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.8 No.2,
February
13,
2018
ABSTRACT: Objectives: Patients with ischemic ventricular arrhythmia (IVA) in the form of
fibrillation or tachycardia represent a surgical challenge. Evidence in the
literature suggests that ventricular arrhythmia threatens survival even after
cardiac surgery. We aim to review the results of our patients presenting with
IVA with regard to short and long term outcome following cardiac surgery.
Methods: This was a retrospective study of data entered prospectively into our
cardiac surgical database between January 1999 and September 2015. A total of
9609 patients underwent Cardiac Surgery which included 54 patients after
surviving IVA. The short- and long-term outcomes were compared to a propensity matched group.
Actuarial survival was calculated using Kaplan Meier analysis. Results: The 54 study group patients were propensity matched on a 1:2 basis with
a control group of non-IVA (n = 108). The baseline preoperative
characteristics and risk factors were similar between the 2 groups and all
cases underwent CABG only. Univariate analysis showed pacing postoperatively
(33.3 vs 66.7%; p = 0.001) and postoperative ventricular arrhythmia (10 vs 22.2%; p = 0.039) to be significantly higher in the IVA group. Cox-multivariate
analysis showed postoperative ventricular arrhythmia in either group (Hazard
ratio = 1.5) to be the only significant factor to impact mortality (p 0.001). Long term survival was not significantly different between the
two groups (10.4; CI: 9.08 - 11.75 vs 9.3; CI: 7.61 - 11.01 yrs, p = 0.3). Conclusion: Cardiac surgery on patients presenting with IVA can be performed safely
yielding short and long term results equivalent to non-IVA cases. These patients should not be denied surgery with consideration
of good long term outcome.