Purpose: Acute myocardial infarction and Heart Failure are major causes of mortality nowadays. Delay in initiating Revascularization after onset of ACS is the most common cause of heart failure in India which has the largest burden of Heart failure patients along with the highest burden of coronary artery disease anywhere in the world. Comprehensive management involves early initiation of prevention, early diagnosis, prompt optimization of guidelines Directed Medical therapy, appropriate and timely interventions which may include surgical Revascularization performed off pump followed by proper Rehabilitation and secondary prevention. We present here our retrospective analyses of outcomes of 2334 cases who had surgical Revascularization, and compared management and outcome before and after initiation of Integrated Approach to comprehensive management of these patients.
Patients and method: We did retrospective analysis of patients who had off pump Coronary Artery bypass (OPCAB) in our unit by single surgeon since January 2004 to April 2023. We divided these patients into Group A (1074) Patients who had OPCAB before November 2011 and Group B :(1260) Patients who had OPCAB after November 2011 since Integrated Approach to deliver Comprehensive cost effective management of OPCAB was initiated. The period between onset of ACS and completion of OPCAB was noted along with number of grafts, ventilation time, inotropic and IABP requirement, ICU and hospital stay. The 30 day mortality and improvement in LVEF, MR as well as PA pressure were noted at 3 months and 12 months after surgery. The patients who had non viable myocardium and found not suitable for surgical revascularization were considered for Cardiac Resynchronization Therapy.
Result: The ventilation time, inotropic and IABP requirement, hospital stay was significantly less in group B. The mortality as well as hospital re-admissions were also lower in group B. Improvement in LVEF; MR and PA pressure was also more in group B.
Conclusion: Comprehensive management improves patient outcomes reduces re- admissions and gives better immediate as well as long term outcome of patients with ischemic heart failure. Early diagnosis and immediately Revascularization helps in preventing heart failure whereas heart Team directed early off pump surgical Revascularization in multi vessel disease improves left ventricular function and gives cost effective survival benefit to patients
Audience Take Away Notes
- The audience will learn about the protocols and benefits of Comprehensive management of ischemic heart failure
- This will help the audience in improving management of Acute MI and prevent heart failure in patients
- This will help other faculty to utilize our experience in management of critically ill patients with ACS needing off pump surgical revascularization