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.
Highlights
Arrhythmias and ischemic heart disease comprise a significant percentage of sudden cardiac death especially in the older population [1] [2]
We aim to review the results of our patients presenting with ischemic ventricular arrhythmia (IVA) with regard to short and long term outcome following cardiac surgery
Patients with ischemic heart disease presenting with ventricular arrhythmias (VA) represent a high risk population compared to the rest of the patients undergoing surgical revascularisation [3]
Summary
Arrhythmias and ischemic heart disease comprise a significant percentage of sudden cardiac death especially in the older population [1] [2]. Patients with ischemic heart disease presenting with ventricular arrhythmias (VA) represent a high risk population compared to the rest of the patients undergoing surgical revascularisation [3]. Randomised control trial on this subgroup of patients is not feasible due to ethical and clinical restraints and a number of studies assessed short and long term outcomes of these ischemic patients presenting with VAs none seems to have a proper control group [4] [5] [6]. In this study we aim to assess the short and long term outcomes of patients undergoing surgical revascularisation following presentation with VA against an equivalent control group by propensity matching. It allows comparable results and conclusions to those of a randomised controlled study [7]
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