CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, May 2013
AFRICA
5
Introduction:
Les patients opérés pour revascularisation chirur-
gicale du myocarde sous CEC sont prédisposés à de nombreuses
complications post-opératoires inhérentes à la biocompatibilité
imparfaite des matériaux utilisées qui génère une réaction inflam-
matoire généralisée. La chirurgie coronaire à cœur battant a été
proposée comme une alternative pour éviter ces complications. Le
but de notre étude est d’évaluer l’intérêt de la chirurgie coronaire
à cœur battant en termes de réduction de la morbidité et mortalité
postopératoire.
Subjects and methods:
Entre Avril 2004 et Décembre 2012, 125
patients ont été opérés pour pontage coronaire à cœur battant dans
le service de chirurgie thoracique et cardio-vasculaire de l’hôpital
A. Mami en Tunisie.
Results:
L’âge moyen de nos patients était de 60.65 ans. La fraction
d’éjection était en moyenne de 47.6% et l’EUROSCORE moyen
était de 4.5. Le nombre de ponts réalisés a évolué au fil des années,
avec exclusivement des mono-pontages en 2004 et 2.17 ponts par
patients en moyenne en 2012, soit une moyenne de 1.64 pont par
patient. Les suites opératoires étaient simples dans la plupart des cas.
Les complications post-opératoires à type d’IDM ont été rapportées
uniquement dans un cas, IVG dans 9 cas (7.2%), ACFA dans 10 cas
(8%) et des troubles du rythme ventriculaires dans 5 cas (4%). Par
ailleurs, nous avons noté peu d’utilisation d’inotropes au-delà de
24h (28.8%) et de transfusion (8%). Les délais d’extubation ont été
inférieurs à 48 h dans la majorité des cas (95%).
Interpretation:
La chirurgie coronaire à cœur battant est une
alternative fiable surtout chez certains malades à haut risque de
morbidité et mortalité péri-opératoire, pour lesquels la CEC serait
greffée d’une forte mortalité.
THE COST OF OPEN HEART SURGERY IN NIGERIA
Bode F*, Sanusi M, Majekodunmi A, Ajose I, Idowu A, Oke D
Introduction:
Open heart surgery (OHS) is not commonly prac-
ticed in Nigeria and most patients who require OHS are referred
abroad. There has recently been a resurgence of interest in estab-
lishing OHS services in Nigeria but the cost is unknown. The aim
of this study was to determine the direct cost of OHS procedures
in Nigeria.
Subjects and methods:
The study was performed prospectively
from November to December 2011. Three concurrent operations
were selected as being representative of the scope of surgery
offered at our institution. These procedures were atrial septal defect
(ASD), off pump coronary artery bypass grafting (OPCAB) and
mitral valve replacement (MVR). Cost categories contributing to
direct costs of OHS (investigations, drugs, perfusion, theatre, inten-
sive care, honorarium and hospital stay) were tracked to determine
the total direct cost for the 3 selected OHS procedures.
Results:
ASD repair cost $6 230 (Drugs $600, Intensive Care $410,
Investigations $955, Perfusion $1080, Theatre $1360, Honorarium
$925, Hospital Stay $900). OPCAB cost $8 430 (Drugs $740,
Intensive Care $625, Investigations $3,020, Perfusion $915,
Theatre $1305, Honorarium $925, Hospital Stay $900). MVR
with bioprosthetic valve cost $11 200 (Drugs $1200, Intensive
Care $500, Investigations $3040, Perfusion $1100, Theatre $3,535,
Honorarium $925, Hospital Stay $900).
Interpretation:
The direct cost of OHS in Nigeria currently ranges
between $6 230 and $11 200. These costs compare favourably with
cost of OHS abroad and can serve as a financial incentive to patients,
sponsors and stakeholders to have OHS procedures done in Nigeria.
OPEN HEART SURGERY IN NIGERIA: A WORK IN
PROGRESS
Bode F*, Sanusi M, Majekodunmi A, Animasahun B, Ajose I,
Idowu A, Oke D
Introduction:
There has been limited success in establishing open
heart surgery (OHS) programmes in Nigeria, despite the high prev-
alence of structural heart disease and the large number of Nigerian
patients that travel abroad for OHS. The challenges and constraints
to the development of OHS in Nigeria need to be identified and
overcome. The aim of this study was to review the experience with
OHS at the Lagos State University Teaching Hospital and highlight
the challenges encountered in developing this programme.
Subjects and methods:
This was a retrospective study of patients
that underwent OHS in our institution. The source of data was a
prospectively maintained database. Extracted data included patient
demographics, indication for surgery, euroscore, complications and
patient outcome.
Results:
51 OHS procedures were done between August 2004 and
December 2011. There were 21 males (41.2%) and 30 females
(58.8%). Mean age was 29 ± 15.6 years. The mean euroscore was
3.8 ± 2.1. The procedures done were mitral valve replacement in 15
patients (29.4%), atrial septal defect repair in 14 patients (27.5%),
ventricular septal defect repair in 8 patients (15.7%), aortic valve
replacement in 5 patients (9.8%), excision of left atrial myxoma
in 2 patients (3.9%), coronary artery bypass grafting in 2 patients
(3.9%), bidirectional glenn shuns in 2 patients (3.9%). Tetralogy of
fallot repair in 2 patients (3.9%) and mitral valve repair in 1 patient
(2%). There were 9 mortalities (17.6%) in this series. Challenges
encountered included the low volume of cases done, an unstable
work environment, limited number of trained staff, difficulty in
obtaining laboratory support, limited financial support and difficult
in moving away from the Cardiac Mission model.
Interpretation:
The OHS programme in our institution is still being
developed but the identified challenges need to be overcome if this
programme is to be sustained. Similar challenges will need to be
overcome by other cardiac stakeholders if other OHS programmes
are to be developed and sustained in Nigeria.
THE ANATOMICAL DISTRIBUTION OF CORONARY
ARTERY LESIONS IN NIGERIAN PATIENTS
Bode F*, Johnson A, Ogunyakin K
Introduction:
The anatomical distribution of coronary artery
lesions is well described in the Western literature but has not been
reported in Nigerian patients. The aim of this study was to decribe
the anatomical distribution of coronary artery lesions in Nigerian
patients.
Subjects and methods:
A retrospective analysis was done of the
cardiac catheterisation records of all patients with ischaemic heart
disease referred to a private cardiac centre in Lagos. Incomplete
records were excluded from analysis. Only significant coronary
lesions with stenosis >70% (and left main stem stenosis >50%)
were included in the analysis. Data analysis was performed with
Microsoft Excel 2010 and results were expressed as mean ± stand-
ard deviation, numbers and percentages as appropriate.
Results:
178 patients underwent cardiac catheterisation for ischae-
mic heart disease between July 2009 and August 2012. 77 patients
had normal coronary angiograms and were excluded from analysis.
Of the 101 patients with abnormal coronary angiograms there were
70 males (69.3%) and 31 females (30.7%). Average age was 58 ±
11.7 years. Distribution of coronary disease by number of vessels
involved was one vessel disease in 36 patients (35.6%), two vessel
disease in 27 patients (26.7%) and three vessel disease in 38 patients
(37.6%). 269 significant coronary lesons were seen. Distribution
of coronary lesions by vessel involvement was LAD proximal 58
(21.8%), RCA proximal 38 (14.3%), LAD mid 33 (12.4%), Cx
proximal 29 (10.3%), RCA mid 16 (6%), Cx mid 15 (5.6%), OM1
15 (5.6%), Diagonal 12 (4.5%), Cx distal 10 (3.8%), RCA-PDA 10
(3.8%), RCA distal 8 (3%), LMS 8 (3%), Intermediate 6 (2.3%),
OM2 6 (2.3%), LAD distal 2 (0.8%), RCA-LV 2 (0.8%) and Cx-PDA
1(0.4%). Overall distribution of lesions was therefore LAD 111
(41.3%), Cx 76 (28.3%), RCA 74 (27.5%) and LMS 8 (3%).
Interpretation:
64% of patients had double or triple vessel disease.
Anatomical distribution of lesions showed LAD lesions predomi-
nating, followed by Cx and RCA lesions. Coronary artery lesions
1,2,3,4,5,6 8,9,10,11,12,13,14,15,16,17,...40