OPEN HEART SURGERY AT A NEWLY DEVELOPED CARDIAC CENTER IN KARACHI: A STEP TOWARDS AFFORDABLE CARDIAC CARE IN PAKISTAN

Objective: To evaluate the outcomes and cost-effectiveness of cardiac surgery performed in a newly developed center providing affordable surgical care. Methods: This descriptive study was conducted at the Medicare Hospital Karachi, from January 2016 to October 2017. Patients undergoing open-heart surgery with cardiopulmonary bypass were enrolled, and those presenting with cardiogenic shock and off-pump cardiac surgeries were excluded. Data were prospectively collected on the designed questionnaire. Results: A 127 consecutive patients, predominantly male, 72%, with an overall median age of 58±15 years were identified. Ninety percent had CABG, 5.5% had MVR, 1.6% had AVR, 0.8% had CABG+MVR, and 1.6% had CABG+AVR. A majority, 50.4%, had 1+2+3 grafts. Sixty percent had a CPB time between 60-90 minutes and ventilation of less than six hours in 88% patients. Peri-operatively 97% of patients received transfusion, 2.4% developed renal dysfunction, 1.6% sepsis, 3.2% arrhythmia, and 71% received inotropes. In-hospital mortality was 1.8%, ICU stay >5 days and hospital stay >8 days was found each in 1.6% of patients respectively. Conclusion: We demonstrated impressive results compared with strong Western standards. Further comparative studies with greater sample size are required to assess the outcomes, survival, and cost-effectiveness in this region. Key words: Coronary artery bypass grafting (CABG), Outcomes, Cost-effectiveness