Date of Award
5-2021
Document Type
Dissertation
Degree Name
Master of Medicine (MMed)
First Supervisor/Advisor
Dr. Peter Ogutu
Second Supervisor/Advisor
Prof. Abdallah Abdulkarim
Third Supervisor/Advisor
Mr. James Orwa
Department
General Surgery (East Africa)
Abstract
Background: Cardiovascular diseases are the number one cause of death worldwide where an estimated 17.9 million people die yearly, according to WHO. Most of this disease burden lies in the low and middle-income countries. Management of cardiovascular diseases can be medical and/or surgical. Open heart surgery is one among the major surgeries performed worldwide. It is well established in high income countries where up to 200,000 cardiac surgeries can be performed yearly. In low-income countries particularly sub-Saharan Africa where most of the disease burden is, there are about 22 centres that cater to this growing need for cardiac surgery. There is overwhelming data available for outcomes of open-heart surgery in the high-income countries, and this is available from nationwide and even multinational databases. In Africa however there is little data available on the outcomes of open-heart surgery. Due to the difference in race and disease pattern, age and severity at presentation between sub-Saharan Africa and the western world, there is a need for more information on the outcomes of these surgeries.
Objective: To determine the outcomes of open-heart surgery in Aga Khan University Hospital 2019-2020.
Methods: This was a retrospective study that looked at the outcomes of open-heart surgery via a composite outcome of Major Adverse Cardiac Events (MACE) which included: 30-day mortality, stroke, acute kidney injury and post-operative infections. We also looked at factors associated with MACE and other complications. Eligible patients who were above 18 years of age operated between January 2019 and January 2020 were included in the study. Data was obtained by a review of patients’ medical records.
Results: 45 patients underwent open heart surgery between January 2019 and 2020. A total of 43 patients were analysed after fulfilling the inclusion criteria. the mean age of the patients was 47.2 years (SD 15.8). The most common cardiovascular disease was rheumatic heart disease 58.1%, with 32% of the patients presenting with double and triple valve disease each. The prevalence of MACE was 11.6% (95% CI 23.7-53%), the overall 30-day mortality irrespective of type of surgery was 7% (95% CI: 2.2-20.3%) where for CABG patients mortality rate was 10%. Patients who had MACE were found to have prolonged CPB time and operative time however this was not statistically significant.
Conclusion: The prevalence of MACE after open heart surgery from this study is 11.6% which is better than that found in the literature, with a mortality rate of 7%. The mortality rate for CABG was higher than that found in literature. Our study sample size was 43 patients, a larger sample size is needed for risk factor analysis.
Recommended Citation
Kahamba, N. J. (2021). Outcomes of cardiac surgery at the Aga Khan University Hospital Nairobi – a one year review (Unpublished master's dissertation). Aga Khan University, East Africa.