الفهرس 
ISCHEMIC HEART DISEASEOnly 14 pages are availabe for public view
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Abstract
I
schemic heart disease is one of the major causes of death, disability and health care resource utilization worldwide but recent advances in operative techniques and perioperative care have resulted in an increasing number of elderly patients undergoing coronary artery bypass grafting (CABG) with significant improvements in health-related quality of life as a marker of outcome after CABG.
CABG is one of the most common surgical procedures performed worldwide. The operation improves survival as well as the quality of life of patients with coronary artery heart disease. The use of the internal mammary artery (IMA) graft has become increasingly popular in CABG operations due to its demonstrated better long-term patency as compared with that of the saphenous vein graft.
The aim of the work was to determine the clinical outcome of GABG in Egyptian Septuagenarian population and to identify risk factors that may adversely affect morbidities and mortality.
This nonrandomized, comparative and prospective with propensity score matching study was conducted in department of cardiothoracic surgery Nasser Institute Hospital (NIH) and Department of cardiothoracic surgery Ain Shams University (ASU).
This study was conducted on 600 patients diagnosed to coronary artery diseases. Patients were divided into 2 groups according to their age at time of operation either patient aged 70 years to 79 years or patient less than 70 years:
• group A: patient less than 70 years .
• group B patient aged 70 years to 79 years.
• Current study results showed that there was statistically significant increase in the percentage of patients with arrhythmia, low cardiac output, reoperation, neurological complications, pulmonary complications, mediastinitis and rewiring and renal impairment in died patients than alive patients. Also the percentage of total morbidity was found higher in died patients than alive patients. The median mechanical ventilation hours, stay on ITU hours and nights was found higher in died patients than alive patients while no statistically significant relation found between total hospital stay and mortality among patients of group B. Also, the percentage of patients with poor ejection fraction post discharge was found higher in died patients than alive patients with p-value <0.001.
The univariate logistic regression analysis showed that all the previous parameters were found significantly associated with mortality except renal finding. Also the multivariate logistic regression analysis shows that the most important factor associated with mortality was found poor post discharge ejection fraction with p-value <0.001 and OR (95% CI) of 259.467 (56.256 – 1196.731).
Also, our results showed that the most important factors associated and affecting the overall survival of the studied patients was found respiratory with HR (95% CI) of 7.483 (1.470 – 38.080) and low cardiac output with HR (95% CI) of 4.090 (1.682 - 9.944) respectively.
CONCLUSION
F
inally, the study findings demonstrates that advanced age impacts surgical outcomes after CABG with Septuagenarians having worse postoperative outcomes including higher complications and mortality than younger cases. Additionally, in Septuagenarians, females had a higher mortality than their male counterparts did. An explanation for the worse outcome in the female group is most likely multifactorial and requires additional explanation. Taken together, our results demonstrate that a careful assessment of older patients must take place to determine the best management strategy to provide coronary revascularization, we recommend versal study for more accurate analysis of the regional blood flow supply to the papillary muscle system, mitral valve and mitral apparatus by Cardiac MRI.