Patterns and Outcomes of Adult Cardiac Surgery in a Tertiary Hospital in Pakistan: A Seven-Year Single-Surgeon Retrospective Study

Patterns and Outcomes of Adult Cardiac Surgery

Abstract

Cardiovascular disease is a major health burden in Pakistan, where access to cardiac surgery is limited. Understanding disease patterns and cardiac surgical procedures in high-burden societies can guide resource allocation to improve patient outcomes. Objectives: To evaluate retrospectively the pattern of adult cardiac surgical procedures and their outcomes performed by a single surgeon at a tertiary hospital in Pakistan. Methods: This retrospective observational study included 1,404 consecutive adult patients operated on by a single surgeon at CPEIC, Multan. Data were collected from all consecutive adult patients (≥15 years), of either sex, who underwent surgery by a single cardiac surgeon between May 2018 and July 2025. The data were obtained from a prospectively maintained surgeon's database. Fisher’s exact test was used for small group comparisons. Results: A total of 1,404 patients underwent cardiac surgery. Coronary artery bypass grafting comprised 70.0% (on‑pump 55.9%, off‑pump 11.3%), valvular surgery 21.6%, congenital repairs 2.3%, aortic root 1.0%, and post-MI VSR repair 1.5%. In isolated CABG, the internal mammary artery was used in 92.4%, with a mean of 2.96 ± 0.93 grafts. Complications occurred in 20.4%. Early mortality was 3.1%, with the lowest rates in CABG (1.9%) and the highest in VSR repair (23.8%). Ventilation time and hospital stay were significantly longer in aortic root and redo procedures (p<0.05). Conclusions: Over seven years, CABG and valvular procedures predominated, with overall mortality and complication rates comparable to regional benchmarks. On-pump CABG provided more complete revascularization, while complex surgeries carried a higher risk.