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Abstract
.Atherosclerosis is the main cause of coronary insufficiency. As the percentage of people with atherosclerosis is in continuous increase, coronary revascularization either by percutaneous transluminal coronary angioplasty (PTCA) or by coronary artery bypass grafting (GABG) are widely used nowadays.
One of the most serious complications of CABG is cardiogenic shock which occurs in about 10 to 15 percent of the cases. Some scholars consider it a medical dilemma owing to the difficulties encountered its diagnosis and choice of the proper treatment (Dilsizian et al., 1988).
Causes of cardiogenic shock after CABG include, interactable arrhythmias, congestive heart failure, cardiac tamponde and early graft failure.
In these circumstances cardiogenic shock can be treated either by pharmacologically using sympathomimetic amines, antiarrhythmic drugs and thrombolytic agents, by inserting an intraaortic balloon or surgically either by reexploration or reoperation for CABG.
It was concluded that:
* Mean age of the participants was 58.8 ± 7.8 years.
* Male to female participants ratio was 3:1.
* Among the complications accompanying cardiogenic shock difficult weaning from mechanical ventilation, arrhythmias, psychic and neurologic complications were found to have the highest incidence.
* It was found that intraaortic balloon counter pulsation (IABP) was very effective in the cases, which were unresponsive to pharmacologic treatment alone.
* Early surgical intervention for CABG reoperation played an important role to rescue those who suffered from early graft failure.
* During 30 days period the mortality rate was found to be 15.3%.
* Mean hospital stay period was found to be 16.96 ± 7.54 days.
Recommendations:
* Conducting further studies on the same field with selection of patients with better health status and following them up for five years.
* We recommend conducting further studies in which gender is taken as an independent risk factor after ruling out other risk factors discussed in this research work.
* Studying the causes and outcome of cardiogenic shock in off-pump coronary grafting.
* Unlike our study IABP should be done maximum within 12 hours after failure of pharmacologic treatment.
* Using more precise predictors to diagnose early graft failure as measuring serum Troponin levels which are not affected by cardiac manipulations as creatine kinase, echocardiographic flow transit time should be used widely for these cases too.
* It is more preferable to seek other reentry sites for coronary graft reoperation other than median sternotomy.