Heart, lung & circulation · 2014
Cardiac surgery in indigenous Australians: early onset cardiac disease with follow-up challenges.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Matebele M P, Rohde S, Clarke A, Fraser J F
Аннотация
OBJECTIVE: To review the risk factors, complications and follow-up of Indigenous patients post cardiac surgery.
METHODS: This was a retrospective study of Indigenous patients who underwent cardiac surgery at an Australian tertiary hospital between 2002 and 2009. Patients' medical notes were reviewed and data collected and analysed.
RESULTS: There were 220 Indigenous patients who had cardiac surgery. Non-elective surgery was performed in 45.0% (99/220). A history of smoking was reported by 76.8% (169/220). The most common operation was coronary artery bypass grafting with a mean age of 55 years. Of the 71 valve operations, 31.0% had rheumatic heart disease. Mechanical valves were given to 56.3% (40/71) of patients with a mean age of 45 years. The rate of peri-operative bleeding requiring blood transfusion or reoperation was 8.6% (19/220) and 28-day mortality was 0.45% (1/220). Of the patients with mechanical valves, 10.0% (4/40) did not present for outpatient review. Late anticoagulation related complications were haemorrhagic stroke 7.5% (3/40) and ischaemic bowel 2.5% (1/40). Late mortality was 9.5% (21/220). Late anticoagulation related deaths were in 1.8% (4/220), of whom 0.9% (2/220) had mechanical valves.
CONCLUSIONS: The mean age of 52 years at which Indigenous patients have cardiac surgery is significantly low compared to non-Indigenous patients. Indigenous patients have multiple risk factors for cardiac disease and with a large number requiring emergency surgery. Although surgical outcome in the short term is favourable, a large number of patients are lost to follow-up. The use of mechanical valve and warfarin should be individualised. Strategic post-operative follow-up mechanisms are needed to address these issues.
METHODS: This was a retrospective study of Indigenous patients who underwent cardiac surgery at an Australian tertiary hospital between 2002 and 2009. Patients' medical notes were reviewed and data collected and analysed.
RESULTS: There were 220 Indigenous patients who had cardiac surgery. Non-elective surgery was performed in 45.0% (99/220). A history of smoking was reported by 76.8% (169/220). The most common operation was coronary artery bypass grafting with a mean age of 55 years. Of the 71 valve operations, 31.0% had rheumatic heart disease. Mechanical valves were given to 56.3% (40/71) of patients with a mean age of 45 years. The rate of peri-operative bleeding requiring blood transfusion or reoperation was 8.6% (19/220) and 28-day mortality was 0.45% (1/220). Of the patients with mechanical valves, 10.0% (4/40) did not present for outpatient review. Late anticoagulation related complications were haemorrhagic stroke 7.5% (3/40) and ischaemic bowel 2.5% (1/40). Late mortality was 9.5% (21/220). Late anticoagulation related deaths were in 1.8% (4/220), of whom 0.9% (2/220) had mechanical valves.
CONCLUSIONS: The mean age of 52 years at which Indigenous patients have cardiac surgery is significantly low compared to non-Indigenous patients. Indigenous patients have multiple risk factors for cardiac disease and with a large number requiring emergency surgery. Although surgical outcome in the short term is favourable, a large number of patients are lost to follow-up. The use of mechanical valve and warfarin should be individualised. Strategic post-operative follow-up mechanisms are needed to address these issues.