Reflecting the growing needs for advanced cardiac care within our population, we recently conducted our first successful coronary artery bypass graft (CABG) surgery case at Impulse Hospital, a new tertiary level private facility in Dhaka City, Bangladesh.
A 65-year-old man was admitted with triple-vessel CAD, hypertension and chronic obstructive pulmonary disease (COPD). There was significant stenosis of left subclavian artery (LSA) before the origin of the left internal mammary artery (LIMA). So we used the right internal mammary artery (RIMA) as a graft. His aorta was calcified at the anterior aspect, so a small size clamp was applied on the right side of the aorta for proximal anastomosis. His operation was on the 16th August 2018. Off-pump CABG x 3 grafts: RIMA to the left anterior descending (LAD) artery, reverse the saphenous vein graft (RSVG) to the posterior descending artery (PDA), and first obtuse marginal (OM1) was undertaken with only minor complications, as operational procedures were smooth and uneventful. The patient was discharged 10 days later in a stable haemodynamic condition with appropriate lifestyle advice, medication, i.e. antiplatelet and lipid-lowering drugs, and advice on regular follow-up evaluation, which is currently, monthly.
The first CABG surgery in a new hospital is always a challenging task in the sense of manpower coordination, shortage of minor instruments or materials, or emergency drugs, etc. Despite all precautions there is always the chance of infection, mortality and morbidity.
The authors would like to thank the Impulse Hospital authority, operating theatre, CICU (Cardiac Intensive Care Unit); surgical and other support staff for their skills and cooperation.
Conflicts of interest
Mohammad G Kibria
Professor and Senior Consultant, Department of Cardiac Surgery
Abu S M Giasuddin
Professor of Biochemistry & Immunology, and Senior Consultant, Department of Laboratory Medicine (firstname.lastname@example.org)
Salah U Ahmed
Professor and Senior Consultant (Cardiac Anaesthesiology), Department of Anaesthesiology
Asif A B Moin
Senior Consultant Cardiac Surgeon, Department of Cardiac Surgery
Impulse Hospital, ImHS & RC Ltd, 304/E Tejgaon Industrial Area, Dhaka-1208, Bangladesh
Amanur R Sumon
Assistant Registrar, Department of Cardiac Surgery
Assistant Registrar, Department of Cardiac Anaesthesiology
Bangabandu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka-1000, Bangladesh
1. WHO/SEARO/Country Office for Bangladesh and Ministry of Health & Family Welfare, Bangladesh. Strategic plan for surveillance and prevention of non-communicable diseases in Bangladesh 2011–2015. Dhaka: Directorate General of Health Services, Ministry of Health and Family Welfare, August 2011. Available from: http://www.searo.who.int/bangladesh/publications/strategic_plan_ncd/en/
2. Islam AKMM, Majumdar AAS. Coronary artery disease in Bangladesh: a review. Indian Heart J 2013;65:424–35. https://doi.org/10.1016/j.ihj.2013.06.004
3. Department of Public Health and Primary Care, University of Cambridge. High-risk hearts: a South Asian epidemic. Published on 30 June 2011. Available at: https://www.cam.ac.uk/research/news/high-risk-hearts-a-south-asian-epidemic [accessed 11 November 2018].