# Surgical Management of Ischemic Heart Disease Patients With Left Ventricular Dysfunction in Lower-Middle-Income Countries: Our Strategies and Experience at the Medical Teaching Institute-Hayatabad Medical Complex (MTI-HMC) Peshawar, Pakistan

## TL;DR

This study examines the outcomes of heart surgery for patients with severe heart failure in Pakistan, showing it can be effective despite risks.

## Contribution

The study provides insights into CABG outcomes for severe LVD in a lower-middle-income country setting.

## Key findings

- Postoperative in-hospital mortality was 4.6% among patients with severe LVD undergoing CABG.
- Comprehensive myocardial revascularization and internal mammary artery grafting contributed to favorable outcomes.
- Most patients (89.4%) underwent elective CABG, with minimal wound infections reported.

## Abstract

Introduction and objectives

Severe left ventricular dysfunction (LVD) in coronary artery disease (CAD) is linked to high risks and limited outcomes. Coronary artery bypass grafting (CABG) remains a key surgical intervention for these patients. This study aimed to assess hospital and short-term outcomes in patients with severe LVD undergoing isolated CABG and identify predictors of adverse outcomes.

Methodology

We conducted a retrospective study of 454 patients who underwent CABG for CAD with significant LVD at Hayatabad Medical Complex between 2018 and 2024. Data were extracted from clinical records and analyzed statistically to evaluate outcomes and predictors.

Results

The study included 454 patients with a mean age of 58.14 ± 9.576 years and a mean ejection fraction of 35.59 ± 3.996%. There were 396 (87.2%) male patients with common comorbidities, including hypertension (122, 26.9%), diabetes mellitus (88, 19.4%), and smoking (39, 8.6%). Intraoperative findings showed a mean cardiopulmonary bypass (CPB) time of 155.94 ± 38.120 minutes, with 451 (99.3%) achieving LIMA (left internal mammary artery) to LAD (left anterior descending artery) revascularization. Postoperative in-hospital mortality was 21 (4.6%), re-intubation occurred in 18 (4.0%), and arrhythmias were observed in 26 (5.7%). Wound infections were minimal (444 (97.8%) without infection), and 406 (89.4%) underwent elective CABG, while nine (2.0%) had emergent CABG, mostly due to ventricular septal rupture.

Conclusion

CABG remains a vital surgical intervention for patients with severe LVD, offering favorable short-term outcomes despite the inherent risks. Key factors contributing to these results include comprehensive myocardial revascularization, effective use of internal mammary artery grafting, and advanced myocardial protection strategies. This study highlights the potential of CABG to improve survival and functional outcomes in this high-risk population.