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Hirnle G, Stankiewicz A, Mitrosz M, Aboul-Hassan SS, Deja M, Rogowski J, Cichoń R, Anisimowicz L, Bugajski P, Tobota Z, Maruszewski B, Hrapkowicz T. Gender Differences in Survival after Coronary Artery Bypass Grafting-13-Year Results from KROK Registry. J Clin Med 2024; 13:4080. [PMID: 39064120 PMCID: PMC11277894 DOI: 10.3390/jcm13144080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
The influence of gender on both early and long-term outcomes of coronary artery bypass grafting (CABG) is not clearly defined. Objectives: This study aimed to assess the impact of gender on early and long-term mortality after CABG using data from the KROK Registry. Methods: All 133,973 adult patients who underwent CABG in Poland between 1 January 2009 and 31 December 2019 were included in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry). The study enrolled 90,541 patients: 68,401 men (75.55%) and 22,140 women (24.45%) who met the inclusion criteria. Then, 30-day mortality, 1-year mortality, and long-term mortality rates were compared. Results: Advanced age, higher Canadian Cardiovascular Society (CCS) and New York Heart Association (NYHA) grade, diabetes, hypercholesterolemia, arterial hypertension, body mass index BMI > 35 kg/m2, and renal failure, before the propensity matching, were more frequently observed in women. Women more frequently underwent urgent surgery, including single and double graft surgery, and off-pump CABG (OPCAB) (p < 0.001). In propensity-matched groups, early mortality (30 days) was significantly higher in women (3.4% versus 2.8%, p < 0.001). The annual mortality remained higher in this group (6.6% versus 6.0%, p = 0.025). However, long-term mortality differed significantly between the groups and was higher in the male group (33.0% men versus 28.8% women, p < 0.001). Conclusions: There are no apparent differences in long-term mortality between the two sexes in the entire population. In propensity-matched patients, early mortality was lower for men, but the long-term survival was found to be better in women.
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Affiliation(s)
- Grzegorz Hirnle
- Department of Cardiac Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (M.M.)
| | - Adrian Stankiewicz
- Department of Cardiac Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (M.M.)
| | - Maciej Mitrosz
- Department of Cardiac Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (M.M.)
| | - Sleiman Sebastian Aboul-Hassan
- Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, 65-417 Zielona Gora, Poland;
| | - Marek Deja
- Department of Cardiac Surgery, Upper-Silesian Medical Centre, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Jan Rogowski
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, 80-211 Gdansk, Poland;
| | - Romuald Cichoń
- Lower Silesian Center for Heart Diseases ‘Medinet’, Faculty of Medicine and Medical Sciences, University of Zielona Gora, 65-417 Zielona Gora, Poland;
| | - Lech Anisimowicz
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, 85-094 Bydgoszcz, Poland;
| | - Paweł Bugajski
- Department of Cardiac Surgery, J. Struś Hospital, 61-285 Poznan, Poland;
| | - Zdzisław Tobota
- Department of Paediatric Cardiothoracic Surgery, Children’s Memorial Health Institute, 01-210 Warszawa, Poland; (Z.T.); (B.M.)
| | - Bohdan Maruszewski
- Department of Paediatric Cardiothoracic Surgery, Children’s Memorial Health Institute, 01-210 Warszawa, Poland; (Z.T.); (B.M.)
| | - Tomasz Hrapkowicz
- Department of Cardiac Surgery, Vascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, 41-800 Zabrze, Poland;
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Zhang CH, Ge YP, Zhong YL, Hu HO, Qiao ZY, Li CN, Zhu JM. Massive Bleeding After Surgical Repair in Acute Type A Aortic Dissection Patients: Risk Factors, Outcomes, and the Predicting Model. Front Cardiovasc Med 2022; 9:892696. [PMID: 35898275 PMCID: PMC9309227 DOI: 10.3389/fcvm.2022.892696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMassive bleeding throughout aortic repair in acute type A aortic dissection (ATAAD) patients is a common but severe condition that can cause multiple serious clinical problems. Here, we report our findings regarding risk factors, short-term outcomes, and predicting model for massive bleeding in ATAAD patients who underwent emergent aortic repair.MethodsA universal definition of perioperative bleeding (UDPB) class 3 and 4 were used to define massive bleeding and comprehensively evaluate patients. A total of 402 consecutive patients were enrolled in this retrospective study during 2019. Surgical strategies used to perform aortic arch procedures included total arch and hemiarch replacements. In each criterion, patients with massive bleeding were compared with remaining patients. Multivariable regression analyses were used to identify independent risk factors for massive bleeding. Logistic regression was used to build the model, and the model was evaluated with its discrimination and calibration.ResultsIndependent risk factors for massive bleeding included male sex (OR = 6.493, P < 0.001), elder patients (OR = 1.029, P = 0.05), low body mass index (BMI) (OR = 0.879, P = 0.003), emergent surgery (OR = 3.112, P = 0.016), prolonged cardiopulmonary bypass time (OR = 1.012, P = 0.002), lower hemoglobin levels (OR = 0.976, P = 0.002), increased D-dimer levels (OR = 1.000, P = 0.037), increased fibrin degradation products (OR = 1.019, P = 0.008), hemiarch replacement (OR = 5.045, P = 0.037), total arch replacement (OR = 14.405, P = 0.004). The early-stage mortality was higher in massive bleeding group (15.9 vs. 3.9%, P = 0.001). The predicting model showed a well discrimination (AUC = 0.817) and calibration (χ2 = 5.281, P = 0.727 > 0.05).ConclusionMassive bleeding in ATAAD patients who underwent emergent aortic repair is highly associated with gender, emergent surgery, increased D-dimer levels, longer CPB time, anemia, and use of a complex surgical strategy. Since massive bleeding may lead to worse outcomes, surgeons should choose suitable surgical strategies in patients who are at a high risk of massive bleeding.
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Ananthanarayanan C, Patel K, Wadhawa V, Patel A, Doshi C, Kothari J, Shah P. Midterm outcome of off-pump CABG for severe LV dysfunction-Does LV size and function predict their midterm outcome? J Card Surg 2021; 36:1000-1009. [PMID: 33503684 DOI: 10.1111/jocs.15362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/12/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The superiority of surgical revascularization in ischemic cardiomyopathy is established beyond doubt, and off-pump CABG (OP-CABG) is a safe way of revascularization in this high-risk subset. Data on the effect of postoperative ventricular function and size on their midterm outcome is scarce. MATERIALS AND METHODS A retrospective study was done on 211 consecutive patients with severe LV dysfunction who underwent OP-CABG from January 2017 to December 2018. Data were collected from the institutional database. Their operative and midterm outcomes were statistically analyzed. RESULTS The mean age of the cohort was 58.4 ± 8.3 years. An average number of grafts was 3.1 ± 0.8 (cumulative intended number of grafts-3). Operative mortality was 10.9%. Preoperative NYHA class (p < .0001; OR, 19.72) and postoperative IABP insertion (p < .008; OR, 88.75) were independent predictors of operative mortality. The mean follow-up period was 3.14 ± 0.07 years, was 97.4% complete with cardiac mortality of 5.8%. Postoperative LVEF (p = .002; OR, 0.868) and LV dimensions (systole & diastole) (p = .013, OR = 1.182 and p = .036, OR = 1.184, respectively) were independent predictors of midterm mortality. Midterm major adverse cardiovascular event-free survival of operative survivors was 89%. There was no correlation between postoperative LV dimension and NYHA status(p > .05). Myocardial viability was not associated with early (p = .17) or midterm mortality (p = .676). CONCLUSION OP-CABG can achieve complete revascularization in patients with severe LV dysfunction with good midterm outcomes, albeit with high early operative mortality. Postoperative change in LV dimension and EF are predictors of midterm mortality.
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Affiliation(s)
- Chandrasekaran Ananthanarayanan
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Kartik Patel
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Vivek Wadhawa
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Archit Patel
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Chirag Doshi
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Jignesh Kothari
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Pratik Shah
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
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Li X, Shan L, Lv M, Li Z, Han C, Liu B, Ge W, Zhang Y. Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG. BMC Cardiovasc Disord 2020; 20:463. [PMID: 33115418 PMCID: PMC7594339 DOI: 10.1186/s12872-020-01745-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/18/2020] [Indexed: 12/14/2022] Open
Abstract
Background Preoperative risk evaluation systems are significant and important to the allocation of medical resources and the communication between doctors and patients. The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is widely used in clinical practice. Cardiac troponin T (cTnT) can specifically and accurately reflect myocardial injury. Whether EuroSCORE II can improve the predictive power after integrating with cTnT is still unclear. This study was a retrospective single center study designed to assess the predictive ability of EuroSCORE II integrated with cTnT for patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG). Methods This retrospective and observational cohort study included 1887 patients who underwent first isolated OPCABG. cTnT was detected within 48 h before operation in each patient. According to myocardial injury, patients were divided by cTnT into 4 stages. A new risk evaluation system was created through logistic regression with EuroSCORE II and myocardial injury classification as covariates. Then the two risk evaluation systems were comparatively assessed by regression analysis, receiver operator characteristic curves, net reclassification index, Bland–Altman plots and decision curve analysis. Results There were 43 in-hospital deaths, with a mortality of 2.30% (43/1887). The logistic regression analysis showed that preoperative myocardial injury classification was a significant risk factor for in-hospital mortality in both total cohort (OR 1.491, 95%CI 1.049–2.119) and subsets (OR 1.761, 95%CI 1.102–2.814). The new risk evaluation system has higher calibration and discrimination power than EuroSCORE II, both for overall cohort and subsets. Especially, the new system has obvious advantages in discrimination power in the subset of acute myocardial infarction (AUC 0.813 vs. 0.772, 0.906 vs. 0.841, and 0.715 vs. 0.646, respectively). Conclusions Both myocardial injury classification and EuroSCORE II are independent risk factors of in-hospital mortality in OPCABG patients. The new risk evaluation system has higher predictive ability than EuroSCORE II, especially in patients with a recent history of AMI.
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Affiliation(s)
- Xiang Li
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, People's Republic of China
| | - Lingtong Shan
- Department of Thoracic Surgery, Sheyang County People's Hospital, Yancheng, Jiangsu, People's Republic of China.,Department of Thoracic Surgery, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University Medical College, Yancheng, Jiangsu, People's Republic of China
| | - Mengwei Lv
- Shanghai East Hospital of Clinical Medical College, Nanjing Medical University, Shanghai, People's Republic of China.,Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, People's Republic of China
| | - Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Chunyan Han
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No.301 Central Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Ban Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No.301 Central Yanchang Road, Shanghai, 200072, People's Republic of China.
| | - Wen Ge
- Department of Cardiothoracic Surgery, Shuguang Hospital, Affiliated to Shanghai University of TCM, Shanghai, People's Republic of China.
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, People's Republic of China.
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Suraci C, Young K, Dove J, Shabahang M, Blansfield J. Predicting Positive Margins in Pancreatic Head Adenocarcinoma After Neoadjuvant Therapy: Investigating Disparities in Quality Care Using the National Cancer Database. Ann Surg Oncol 2020; 28:1595-1601. [PMID: 32856228 DOI: 10.1245/s10434-020-08766-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND In pancreatic cancer, surgical resection with neoadjuvant therapy improves survival, but survival relies significantly on the margin status of the resected tissue. This study aimed to develop a model that predicts margin positivity, and then to identify facility-specific factors that influence the observed-to-expected (O/E) ratio for positive margins among facilities. METHODS This retrospective review analyzed patients in the National Cancer Database (2004-2016) with pancreatic head adenocarcinoma [tumor-node-metastasis (TNM) stage 1 or 2] who received neoadjuvant therapy for a pancreaticoduodenectomy. Logistic regression was used to develop a model that predicts margin positivity. This model then was used to identify outlier facilities with regard to the O/E ratio. Hospital volume was defined as the total number of pancreaticoduodenectomies per year. RESULTS The study enrolled 4085 patients, and 16.8% of these patients had positive margins. Most of the patients (64%) had a tumor size of 2 to 4 cm, and approximately 51% of the patients did not have positive lymph nodes at resection. A logistic regression model showed that the predictors of positive margins after resection with neoadjuvant therapy were male sex, larger tumor size, and positive lymph nodes. This model was validated to yield a bootstrap-corrected concordance index of 0.632. The study calculated O/E ratios with the model, identifying 12 low- and 17 high O/E-ratio outlier facilities among 401 studied hospitals. The outlier hospitals did not differ in facility type (i.e., academic vs integrated network), but did differ significantly in terms of yearly hospital volume (low outlier of 20.6 vs high outlier of 10.7; p = 0.008). CONCLUSIONS An association of lower-volume facilities with higher than expected rates of positive margins was found to indicate a disparity in care. This disparity was identified via an O/E ratio as a quality indicator for facilities. Facilities can gauge the efficiency of their own practices by referencing their O/E ratios, and they also can improve their practices by analyzing the framework of low O/E-ratio facilities.
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Affiliation(s)
- Corey Suraci
- Department of General Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Katelyn Young
- Department of General Surgery, Geisinger Medical Center, Danville, PA, USA
| | - James Dove
- Department of General Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Mohsen Shabahang
- Department of General Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Joseph Blansfield
- Department of General Surgery, Geisinger Medical Center, Danville, PA, USA.
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High-sensitivity C-reactive protein as a prognostic marker in patients undergoing valve surgery. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:15-19. [PMID: 32728357 PMCID: PMC7379212 DOI: 10.5114/kitp.2020.94185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/23/2020] [Indexed: 11/17/2022]
Abstract
Introduction An inflammatory reaction is a local or systemic response of the organs or tissues of the body to many damaging factors. One of the exponents of the inflammatory process is C-reactive protein (CRP). Aim To investigate the prognostic value of C-reactive protein (CRP) in patients undergoing valve surgery. Material and methods A prospective study was conducted on a group of consecutive patients with haemodynamically significant valve defects who underwent elective valve repair or replacement surgery. The primary end-point was in-hospital death from all causes. Patients were followed by direct observation during hospitalization. The risk of surgery using Euro-SCORE II was calculated for each patient. The plasma levels of C-reactive protein were measured by the Cardiac C-Reactive Protein (Latex) High Sensitive Test (Roche, Germany). Results The study group included 562 patients. The mean age in the studied population was 63 (standard deviation (SD) ±12). The mean plasma preoperative CRP level was 0.39 ±0.3 mg/dl. The primary endpoint occurred in 25 patients. At multivariate analysis age (p = 0.01), CRP (p = 0.02) and NT-proBNP (p = 0.03) remained independent predictors of the primary endpoint. A significant correlation was found between the level of CRP and haemoglobin (r = -0.3; p < 0.0001), red cell distribution width (r = 0.22; p < 0.0001), ejection fraction (r = -0.24, p = 0.007), troponin T (r = 0.3; p < 0.0001), creatinine (r = 0.26; p = 0.001) and body mass index (r = -0.29; p = 0.005). The average total time of hospitalization after the operation in patients with occurrence of the primary endpoint was 25 ±13 days. Conclusions Elevated preoperative CRP was associated with a poorer outcome following valve surgery.
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Bolliger D, Mauermann E. Re-exploration After Cardiac Surgery Impairs Outcome—But How to Stratify the Risk? J Cardiothorac Vasc Anesth 2019; 33:2938-2940. [DOI: 10.1053/j.jvca.2019.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/30/2019] [Indexed: 11/11/2022]
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