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Ren J, Bowyer A, Tian DH, Royse C, El-Ansary D, Royse A. Multiple arterial vs. single arterial coronary artery bypass grafting: sex-related differences in outcomes. Eur Heart J 2024; 45:2536-2544. [PMID: 38820177 DOI: 10.1093/eurheartj/ehae294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/24/2024] [Accepted: 04/30/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND AND AIMS Uncertainty exists over whether multiple arterial grafting has a sex-related association with survival after coronary artery bypass grafting. This study aims to compare the long-term survival of using multiple arterial grafting vs. single arterial grafting in women and men undergoing coronary artery bypass grafting. METHODS The retrospective study used the Australian and New Zealand Society of Cardiothoracic Surgical Database with linkage to the National Death Index. Patients from 2001 to 2020 were identified. Sex-stratified, inverse probability weighted Cox proportional hazard model was used to facilitate survival comparisons. The primary outcome was all-cause mortality. RESULTS A total number of 54 275 adult patients receiving at least two grafts in primary isolated bypass operations were analysed. The entire study cohort consisted of 10 693 (19.7%) female patients and 29 711 (54.7%) multiple arterial grafting procedures. At a median (interquartile range) postoperative follow-up of 4.9 (2.3-8.4) years, mortality was significantly lower in male patients undergoing multiarterial than single arterial procedures (adjusted hazard ratio 0.82; 95% confidence interval 0.77-0.87; P < .001). The survival benefit was also significant for females (adjusted hazard ratio 0.83; 95% confidence interval 0.76-0.91; P < .001) at a median (interquartile range) follow-up of 5.2 (2.4-8.7) years. The interaction model from Cox regression suggested insignificant subgroup effect from sex (P = .08) on the observed survival advantage. The survival benefits associated with multiple arterial grafting were consistent across all sex-stratified subgroups except for female patients with left main coronary disease. CONCLUSIONS Compared to single arterial grafting, multiple arterial revascularization is associated with improved long-term survival for women as well as men.
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Affiliation(s)
- Justin Ren
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne 3052, Australia
| | - Andrea Bowyer
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia
- Department of Anesthesia, Royal Melbourne Hospital, Melbourne, Australia
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
| | - David H Tian
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
| | - Colin Royse
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia
- Department of Anesthesia, Royal Melbourne Hospital, Melbourne, Australia
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
| | - Doa El-Ansary
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia
- School of Biomedical and Health Sciences, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Alistair Royse
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne 3052, Australia
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Nomali M, Heidari ME, Ayati A, Moghaddam K, Mosallami S, Khosravi A, Rafiei M, Riahinokandeh G, Yadegari M, Nomali M, Taheriyan M, Roshandel G. Risk factors of in-hospital mortality for isolated on-pump coronary artery bypass graft surgery in the northeast of Iran from 2007 to 2016. Ir J Med Sci 2023; 192:3029-3037. [PMID: 36763195 DOI: 10.1007/s11845-023-03298-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Coronary artery bypass graft (CABG) surgery is the most common cardiac surgery worldwide. The reported mortality rates for this operation vary greatly. We aimed to determine the risk factors of in-hospital mortality for isolated on-pump CABG surgery. METHODS This was a large-scale retrospective cohort study of two heart centers in Golestan province. Patients over the age of 18 from both genders who underwent isolated on-pump CABG procedures from 2007 to 2016 were included. The study outcome was in-hospital mortality, which was determined according to the clinical records of study patients. RESULTS A total of 3704 patients were included in the study, and 63% were men. In-hospital mortality occurred in 2.8% (n=103) of the patients. The median (IQR) age of survived and not-survived patients were 59 (53-65) and 62 (55-75) years, respectively. 44% of the mortalities occurred in patients older than 65, while 28% of the survivors were older than 65. Multivariable logistic regression indicated that emergency CABG (OR 4.52, 95% CI, 1.45, 14.02; P = 0.009) and cardiopulmonary bypass time (CPB) (OR 1.004, 95% CI 1.001, 1.008; P = 0.034) were the risk factors of in-hospital mortality. The area under the receiver operating characteristic (ROC) curve (AUC) of the model consisting of operative and preoperative variables was 0.70 (acceptable performance). CONCLUSION Our study revealed an acceptable mortality proportion for CABG surgeries conducted in the region. Emergency CABG and CPB time were the main risk factors for in-hospital mortality after CABG.
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Affiliation(s)
- Mahin Nomali
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Eghbal Heidari
- Student Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Keyvan Moghaddam
- Supervisory Department, Kordkuy Amiralmomenin Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Soheil Mosallami
- Open Heart Intensive Care Unit, Kordkuy Amiralmomenin Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Afifeh Khosravi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Rafiei
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamali Riahinokandeh
- Department of Surgery, School of Medicine, Sayyad Shirazi Hospital, Kordkuy Amiralmomenin Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Yadegari
- Bandar-E Gaz Shohada Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahdis Nomali
- Department of Biomedical Engineering, Alejalil Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Moloud Taheriyan
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
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Akintoye OO, Fasina OP, Adiat TS, Nwosu PU, Olubodun MO, Adu BG. Outcomes of Coronary Artery Bypass Graft Surgery in Africa: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e47541. [PMID: 37881326 PMCID: PMC10597594 DOI: 10.7759/cureus.47541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 10/27/2023] Open
Abstract
Coronary artery bypass graft (CABG) surgery has been in practice for many decades, and it is one of the most commonly performed cardiac surgeries worldwide. While there are several studies reporting data on perioperative outcomes following CABG in developed countries, there is a staggering paucity of data and evidence reporting the outcomes in developing areas such as Africa. Thus, it is important to study the practice and outcome of CABG in Africa to establish its clinical efficacy and safety in this region and identify factors that might be limiting its practice. The overall aim of this study is to identify all relevant clinical data on CABG in Africa and report on the perioperative outcomes and practice of CABG in the African population. Electronic search was performed using three online databases, PubMed, African Journal Online, and Research Gate, from inception to June 2023. The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline was utilised for this study. Relevant studies fulfilling predefined eligibility criteria were included in the study. Intraoperative details, such as the number of grafts performed, operative, bypass, and cross-clamp time, were reported. The primary endpoint assessed were early mortality and overall mortality. The secondary endpoints included length of hospital stay, intensive care unit stay, and postoperative complications, such as renal impairment, atrial fibrillation, and surgical site infection. The data were pooled together and meta-analyzed using a random effect model for proportions and mean for meta-analysis with R software (version 4.3.1 (2023-06-16); R Development Core Team, Vienna, Austria). This systematic review identified 42 studies that fulfilled the study eligibility criteria, including 21 randomised controlled trials, 20 observational studies, and one cross-sectional study. Only four out of the 54 countries in Africa had studies carried out that met the criteria for this review; they included Algeria, Egypt, Nigeria, and South Africa, with a majority from Egypt. Meta-analysis reported a pooled early mortality and pooled overall mortality of 3.51% and 3.73%, respectively, for the total cohort of patients. The result of this meta-analysis suggests that mortality outcomes following CABG in Africa are relatively higher than those in developed nations. Several issues, such as lack of financial resources and poor infrastructure, continue to hinder the optimal practice of CABG procedures in many parts of Africa. Further studies focused on finding factors associated with outcomes following CABG should be done. Though there were a few limitations to the study largely from a lack of data from several regions and countries in Africa, the result from this meta-analysis can serve as a benchmark for future studies until more relevant data are reported.
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Affiliation(s)
| | - Oyinlola P Fasina
- Cardiothoracic Surgery, Surgery Interest Group of Africa, Lagos, NGA
| | - Tijani S Adiat
- Cardiothoracic Surgery, Surgery Interest Group of Africa, Lagos, NGA
| | - Promise U Nwosu
- Cardiothoracic Surgery, Surgery Interest Group of Africa, Lagos, NGA
| | | | - Bukola G Adu
- Cardiothoracic Surgery, Surgery Interest Group of Africa, Lagos, NGA
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Atrial fibrillation in patients with coronary heart disease: current state of the problem. КЛИНИЧЕСКАЯ ПРАКТИКА 2021. [DOI: 10.17816/clinpract84464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Atrial fibrillation is one of the most common types of cardiac arrhythmia observed in clinical practice. Despite advances in the diagnosis and treatment, atrial fibrillation remains one of the leading causes of cardiovascular mortality and morbidity. In addition, atrial fibrillation is quite often combined with other pathologies of the cardiovascular system and is a marker of an unfavorable outcome. Several previous studies have demonstrated reduced survival in patients with coronary artery disease and atrial fibrillation who have not undergone surgery for arrhythmia. According to other data, the presence of preoperative atrial fibrillation among patients undergoing isolated coronary artery bypass grafting was associated with significantly higher rates of major postoperative complications. Nowadays, no one doubts the fact that atrial fibrillation during a coronary artery bypass surgery is a risk factor for increased hospital mortality, postoperative morbidity and leads to a decrease in the long-term survival. The studies confirm the necessity of surgical ablation for atrial fibrillation during coronary revascularization to reduce both short-term and long-term postoperative mortality and late complications.
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Roman M. Are neural networks the ultimate risk prediction models in patients at high risk of acute myocardial infarction? Eur J Prev Cardiol 2020; 27:2045-2046. [PMID: 31992062 DOI: 10.1177/2047487319890972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marius Roman
- Department of Cardiovascular Sciences and National Institute for Health Research, University of Leicester, UK
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Management of Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: Review of the Literature. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 13:383-390. [PMID: 30516572 DOI: 10.1097/imi.0000000000000570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Untreated atrial fibrillation is associated with an increased risk of all-cause mortality and morbidity. Despite the current guidelines recommending surgical ablation of atrial fibrillation at the time of coronary artery bypass surgery, most patients with concomitant atrial fibrillation and coronary artery disease do not receive surgical ablation for their atrial fibrillation. This review reports the efficacy of different surgical ablation techniques used for the treatment of atrial fibrillation during coronary artery bypass. PubMed was systematically searched for studies reporting outcomes of concomitant surgical ablation in coronary artery bypass patients between January 2002 and March 2018. Data were independently extracted and analyzed by two investigators. Twenty-four studies were included. Twelve studies exclusively reported outcomes of surgical ablation in patients undergoing coronary artery bypass, whereas the remaining 12 reported outcomes of concomitant cardiac surgery with subgroup analysis. Only four studies performed the concomitant Cox-Maze procedure. Freedom from atrial tachyarrhythmia was reported as high as 98% at 1 year and 76% at 5 years with Cox-Maze procedure, whereas lesser lesion sets had more variable outcomes, ranging from 35% to 93%. In most studies, the addition of surgical ablation was not associated with increased morbidity and mortality. Although the Cox-Maze procedure had the greatest short- and long-term success rates, most studies comprising the evidence documenting the safety and efficacy of adding surgical ablation were of low or moderate quality. There was a great deal of heterogeneity among study populations, follow-up times, methods, and definition of failure. To establish a consensus regarding a surgical ablation technique for atrial fibrillation in coronary artery bypass population, larger multicenter randomized controlled studies need to be designed.
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Sherbuk JE, Okamoto EE, Marks MA, Fortuny E, Clark EH, Galdos-Cardenas G, Vasquez-Villar A, Fernandez AB, Crawford TC, Do RQ, Flores-Franco JL, Colanzi R, Gilman RH, Bern C. Biomarkers and mortality in severe Chagas cardiomyopathy. Glob Heart 2016; 10:173-80. [PMID: 26407513 DOI: 10.1016/j.gheart.2015.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/16/2015] [Accepted: 07/09/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chagas cardiomyopathy is a chronic sequela of infection by the parasite, Trypanosoma cruzi. Advanced cardiomyopathy is associated with a high mortality rate, and clinical characteristics have been used to predict mortality risk. Though multiple biomarkers have been associated with Chagas cardiomyopathy, it is unknown how these are related to survival. OBJECTIVES This study aimed to identify biomarkers associated with mortality in individuals with severe Chagas cardiomyopathy in an urban Bolivian hospital. METHODS The population included individuals with and without T. cruzi infection recruited in an urban hospital in Santa Cruz, Bolivia. Baseline characteristics, electrocardiogram findings, medications, and serum cardiac biomarker levels (B-type natriuretic peptide [BNP], N-terminal pro-B-type natriuretic peptide [NT-proBNP], creatine kinase-myocardial band [CK-MB], troponin I, matrix metalloproteinase [MMP]-2, MMP-9, tissue inhibitor of metalloproteinases [TIMP] 1 and 2, transforming growth factor [TGF] beta 1 and 2) were ascertained. Echocardiograms were performed on those with cardiac symptoms or electrocardiogram abnormalities at baseline. Participants were contacted approximately 1 year after initial evaluation; deaths were reported by family members. Receiver-operating characteristic curves (ROC) were used to optimize cutoff values for each marker. For markers with area under the curve (AUC) >0.55, Cox proportional hazards models were performed to determine the hazards ratio (HR) and 95% confidence interval (CI) for the association of each marker with mortality. RESULTS The median follow-up time was 14.1 months (interquartile range 12.5, 16.7). Of 254 individuals with complete cardiac data, 220 (87%) had follow-up data. Of 50 patients with severe Chagas cardiomyopathy at baseline, 20 (40%) had died. Higher baseline levels of BNP (HR: 3.1, 95% CI: 1.2 to 8.4), NT-proBNP (HR: 4.4, 95% CI: 1.8 to 11.0), CK-MB (HR: 3.3, 95% CI: 1.3 to 8.0), and MMP-2 (HR: 4.2, 95% CI: 1.5 to 11.8) were significantly associated with subsequent mortality. CONCLUSIONS Severe Chagas cardiomyopathy is associated with high short-term mortality. BNP, NT-proBNP, CK-MB, and MMP-2 have added predictive value for mortality, even in the presence of decreased ejection fraction and other clinical signs of congestive heart failure.
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Affiliation(s)
| | - Emi E Okamoto
- Hospital of University of Pennsylvania, Philadelphia, PA, USA
| | - Morgan A Marks
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Merck and Co. Inc., West Point, PA, USA
| | - Enzo Fortuny
- Universidad Catolica Boliviana, Santa Cruz, Plurinational State of Bolivia
| | - Eva H Clark
- Baylor College of Medicine, Houston, TX, USA
| | - Gerson Galdos-Cardenas
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Universidad Catolica Boliviana, Santa Cruz, Plurinational State of Bolivia
| | | | | | | | - Rose Q Do
- Veterans Affairs Medical Center and University of Colorado School of Medicine, Denver, CO, USA
| | | | - Rony Colanzi
- Universidad Catolica Boliviana, Santa Cruz, Plurinational State of Bolivia
| | - Robert H Gilman
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caryn Bern
- University of California San Francisco, San Francisco, CA, USA.
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Poullis M, Pullan M. Letter by Poullis and Pullan Regarding Article, "Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes: Insights From the Project of Ex-Vivo Vein Graft Engineering via Transfection (PREVENT) IV Trial". Circulation 2016; 133:e664. [PMID: 27217438 DOI: 10.1161/circulationaha.116.021513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Mark Pullan
- Liverpool Heart and Chest Hospital, Liverpool, England
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Poullis M. e Comment. On-pump versus off-pump revascularization. Interact Cardiovasc Thorac Surg 2016; 22:619. [PMID: 27114394 DOI: 10.1093/icvts/ivw077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Poullis M. Letter by Poullis Regarding Article, "Efficacy of Long-Term β-Blocker Therapy for Secondary Prevention of Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery". Circulation 2016; 133:e391. [PMID: 26858297 DOI: 10.1161/circulationaha.115.018190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Singh AK, Maslow AD, Machan JT, Fingleton JG, Feng WC, Schwartz C, Rotenberg FA, Bert AA. Long-term survival after use of internal thoracic artery in octogenarians is gender related. J Thorac Cardiovasc Surg 2015; 150:891-9. [DOI: 10.1016/j.jtcvs.2015.07.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/01/2015] [Accepted: 07/18/2015] [Indexed: 11/30/2022]
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Do age, diabetes and left ventricular function affect the outcomes of ischemic mitral valve repair? POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 11:239-45. [PMID: 26336429 PMCID: PMC4283876 DOI: 10.5114/kitp.2014.45670] [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: 03/12/2014] [Revised: 03/12/2014] [Accepted: 06/20/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION It is well documented that older age, chronic concomitant diseases (such as diabetes mellitus, chronic obstructive lung disease, etc.), and poor left ventricular function can increase the postoperative complication rate and worsen the general outcomes of coronary artery bypass (CABG) and concomitant repair of ischemic mitral regurgitation (MR). MATERIAL AND METHODS Retrospective data of 394 patients after CABG and mitral valve (MV) repair (mainly annuloplasty) were analyzed. Patients were grouped according to age, diabetes mellitus (DM), and left ventricular ejection fraction (LVEF). Echocardiography data, the rate of postoperative complications (cardiogenic shock, preoperative myocardial infarction, bleeding from the gastrointestinal tract, cognitive disorders, stroke, sepsis, deep wound infection), and early and late mortality were compared between paired groups. RESULTS There were no differences between age groups in reverse positive remodeling of LV. A significantly higher incidence of sepsis and deep wound infection in younger patients was observed. Patients with DM had no change in the pre-postoperative NYHA class and a higher rate of perioperative MI (10.3% vs. 3.1% respectively, p < 0.05) in comparison to patients with no DM. In all LVEF groups, MR was significantly decreased, but reverse positive remodeling of LV was pronounced only in those with "poor" and "moderately lowered" LVEF. Postoperative complications did not differ among these three groups. CONCLUSIONS Elderly age, concomitant DM and lowered LVEF do not influence either early or late mortality, including early postoperative outcomes after MV repair for ischemic MR following CABG. Concomitant DM increases the rate of perioperative MI and impairs reverse remodeling of LV.
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Bansal B, Mithal A, Carvalho P, Mehta Y, Trehan N. Feasibility, efficacy, and safety of a simple insulin infusion protocol in a large volume cardiac surgery unit in India. Indian J Endocrinol Metab 2015; 19:47-51. [PMID: 25593825 PMCID: PMC4287778 DOI: 10.4103/2230-8210.146864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIM Inpatient hyperglycemia management is essential, but difficult to achieve especially in a large volume cardiac surgery setup, thus necessitating use of nurse-led insulin protocols. A rapid flux of nurses dealing with a huge workload has been a cause for traditionally not using nurse-led protocols in most Indian institutes. The challenges we faced were to have a simple protocol for the nurses to accept it without compromising on glycemic control. Therefore, this observational study was planned to measure the efficacy and safety of the insulin infusion protocol in cardiac surgery patients. MATERIALS AND METHODS Insulin protocol was implemented, using seven fixed columns of infusion with the nurse making decisions to initiate and titrate doses based on simple rules. Blood glucose (BG) data captured from blood gas analyzers (glucometrics) in the intervention group (i.e., after protocol implementation) were compared to control group (i.e., before the protocol implementation). RESULTS The mean BG for the first 48 h was lower in the intervention group as compared to control group, without an increase in the episodes of hypoglycemia. The nurses found the protocol easy to understand, less time-consuming and there was no protocol deviation over 8 months after implementation. CONCLUSION A small change in the process, allowing nurses to titrate insulin doses based on some rules and having seven fixed columns of insulin infusion rates, improved glycemic control and efficiency.
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Affiliation(s)
- Beena Bansal
- Division of Endocrinology and Diabetes, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Ambrish Mithal
- Division of Endocrinology and Diabetes, Medanta - The Medicity, Gurgaon, Haryana, India
| | | | - Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Naresh Trehan
- Heart Institute-Division of Cardiothoracic and Vascular Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
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Poullis M. eComment. Preoperative atrial fibrillation and outcome in patients undergoing on-pump or off-pump coronary bypass surgery. Interact Cardiovasc Thorac Surg 2014; 20:78. [PMID: 25525090 DOI: 10.1093/icvts/ivu362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Poullis M. eComment. Does body mass index impact the early outcome of surgical revascularization? Off-pump versus on-pump coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2014; 19:755. [PMID: 25344568 DOI: 10.1093/icvts/ivu309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Poullis M, Kolh P. Analysis of on-pump and off-pump surgery in the Arterial Revascularization Trial. Eur J Cardiothorac Surg 2014; 47:1065-6. [PMID: 25217502 DOI: 10.1093/ejcts/ezu356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Philippe Kolh
- Department of Cardiovascular Surgery, University Hospital of Liege, CHU Sart Tilman, Liege, Belgium
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Stevanovic A, Coburn M, Menon A, Rossaint R, Heyland D, Schälte G, Werker T, Wonisch W, Kiehntopf M, Goetzenich A, Rex S, Stoppe C. The importance of intraoperative selenium blood levels on organ dysfunction in patients undergoing off-pump cardiac surgery: a randomised controlled trial. PLoS One 2014; 9:e104222. [PMID: 25118980 PMCID: PMC4132095 DOI: 10.1371/journal.pone.0104222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/21/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Cardiac surgery is accompanied by an increase of oxidative stress, a significantly reduced antioxidant (AOX) capacity, postoperative inflammation, all of which may promote the development of organ dysfunction and an increase in mortality. Selenium is an essential co-factor of various antioxidant enzymes. We hypothesized a less pronounced decrease of circulating selenium levels in patients undergoing off-pump coronary artery bypass (OPCAB) surgery due to less intraoperative oxidative stress. METHODS In this prospective randomised, interventional trial, 40 patients scheduled for elective coronary artery bypass grafting were randomly assigned to undergo either on-pump or OPCAB-surgery, if both techniques were feasible for the single patient. Clinical data, myocardial damage assessed by myocard specific creatine kinase isoenzyme (CK-MB), circulating whole blood levels of selenium, oxidative stress assessed by asymmetric dimethylarginine (ADMA) levels, antioxidant capacity determined by glutathionperoxidase (GPx) levels and perioperative inflammation represented by interleukin-6 (IL-6) levels were measured at predefined perioperative time points. RESULTS At end of surgery, both groups showed a comparable decrease of circulating selenium concentrations. Likewise, levels of oxidative stress and IL-6 were comparable in both groups. Selenium levels correlated with antioxidant capacity (GPx: r = 0.720; p<0.001) and showed a negative correlation to myocardial damage (CK-MB: r = -0.571, p<0.001). Low postoperative selenium levels had a high predictive value for the occurrence of any postoperative complication. CONCLUSIONS OPCAB surgery is not associated with less oxidative stress and a better preservation of the circulating selenium pool than on-pump surgery. Low postoperative selenium levels are predictive for the development of complications. TRIAL REGISTRATION ClinicalTrials.gov NCT01409057.
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Affiliation(s)
- Ana Stevanovic
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Mark Coburn
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Ares Menon
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital, RWTH Aachen, Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Daren Heyland
- Kingston General Hospital, Kingston, Ontario, Canada
| | - Gereon Schälte
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Thilo Werker
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Willibald Wonisch
- Institute of Physiological Chemistry, Centre for Physiological Medicine, Medical University of Graz, Graz, Austria
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Michael Kiehntopf
- Institute of Clinical Chemistry, Friedrich-Schiller University, Jena, Germany
| | - Andreas Goetzenich
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital, RWTH Aachen, Aachen, Germany
| | - Steffen Rex
- Department of Anaesthesiology and Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven, Belgium
| | - Christian Stoppe
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital, RWTH Aachen, Aachen, Germany
- Institute of Biochemistry and Molecular Cell Biology, RWTH Aachen University, Aachen, Germany
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18
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Bansal B, Mithal A, Carvalho P, Mehta Y, Trehan N. Medanta insulin protocols in patients undergoing cardiac surgery. Indian J Endocrinol Metab 2014; 18:455-467. [PMID: 25143899 PMCID: PMC4138898 DOI: 10.4103/2230-8210.137486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Hyperglycemia is common in patients undergoing cardiac surgery and is associated with poor outcomes. This is a review of the perioperative insulin protocol being used at Medanta, the Medicity, which has a large volume cardiac surgery setup. Preoperatively, patients are usually continued on their preoperative outpatient medications. Intravenous insulin infusion is intiated postoperatively and titrated using a column method with a choice of 7 scales. Insulin dose is calculated as a factor of blood glucose and patient's estimated insulin sensitivity. A comparison of this protocol is presented with other commonly used protocols. Since arterial blood gas analysis is done every 4 hours for first two days after cardiac surgery, automatic data collection from blood gas analyzer to a central database enables collection of glucose data and generating glucometrics. Data auditing has helped in improving performance through protocol modification.
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Affiliation(s)
- Beena Bansal
- Senior Consultant, Division of Endocrinology and Diabetes, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Ambrish Mithal
- Chairman, Division of Endocrinology and Diabetes, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Pravin Carvalho
- Scientist, Gida Technology Services, Bangalore, Karnataka, India
| | - Yatin Mehta
- Chairman, Institute of Critical Care and Anaesthesiology, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Naresh Trehan
- Chairman, Heart Institute-Division of Cardiothoracic and Vascular Surgery, Medanta, The Medicity, Gurgaon, Haryana, India
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Zeriouh M, Sabashnikov A, Choi YH, Fatullayev J, Reuter H, Popov AF, Langebartels G, Kimmig L, Rahmanian PB, Wittwer T, Neef K, Wippermann J, Wahlers T. A novel treatment strategy of new onset atrial fibrillation after cardiac surgery: an observational prospective study. J Cardiothorac Surg 2014; 9:83. [PMID: 24886207 PMCID: PMC4045875 DOI: 10.1186/1749-8090-9-83] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/24/2014] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The aim of this prospective observational study was to evaluate the efficiency of a new escalating treatment strategy with vernakalant, flecainide and electrical cardioversion (EC) in patients with new onset atrial fibrillation (AF) after cardiac surgery. MATERIAL AND METHODS 24 patients with new onset AF after aortic valve surgery, coronary artery bypass surgery or combined procedures were evaluated in this study. Additional including criteria were age between 18 and 80, duration of AF less than four days, body weight less than 100 kg and no previous treatment with class I or III antiarrhythmic drugs. Exclusion criteria were poor left ventricular ejection fraction (LVEF < 40%) and history of myocardial infarction within 30 days. The patients were divided into converters and non-converters according to their response to combination treatment with vernakalant and flecainide, and the groups were compared. RESULTS The mean age of the population was 69.6 ± 6.3 years and 26.1% of patients were female. There were no statistically significant differences between the two groups in terms of height, weight, gender distribution, comorbidities, preoperative medication, left ventricular function and left atrium diameter. Interventricular septum (IVS) in the non-converted group was significantly thicker compared to the converted group: 14.0 ± 1.00 vs. 10.40 ± 2.59 mm (p = 0.036). While 14 patients (60.9%) were successfully converted into stable sinus rhythm by pharmacological treatment with vernakalant and flecainide, 9 patients (39.1%, non-converted group) remained in AF. However, seven of them could be converted after additional EC. CONCLUSION The combination of vernakalant and flecainide improves the conversion rate into a stable sinus rhythm in postcardiotomy patients with new onset AF compared to single drug therapy. Furthermore it might be an excellent precondition for successful EC in patients who are not converted after using both antiarrhtythmic drugs. Furthermore, left ventricular hypertrophy might be a potential negative predictor of successful pharmacological cardioversion.
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Affiliation(s)
- Mohamed Zeriouh
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Javid Fatullayev
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Hannes Reuter
- Department of Cardiology, Pneumology and Angiology, Heart Center of the University of Cologne, Cologne, Germany
| | - Aron-Frederik Popov
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Goettingen, Goettingen, Germany
| | - Georg Langebartels
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Lucas Kimmig
- Department of Cardiology, Pneumology and Angiology, Heart Center of the University of Cologne, Cologne, Germany
| | - Parwis B Rahmanian
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Thorsten Wittwer
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Klaus Neef
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Jens Wippermann
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
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20
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Chalmers J, Pullan M, Mediratta N, Poullis M. A need for speed? Bypass time and outcomes after isolated aortic valve replacement surgery. Interact Cardiovasc Thorac Surg 2014; 19:21-6. [DOI: 10.1093/icvts/ivu102] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pullan M, Kirmani BH, Conley T, Oo A, Shaw M, McShane J, Poullis M. The effect of patient sex on survival in patients undergoing isolated coronary artery bypass surgery receiving a radial artery. Eur J Cardiothorac Surg 2014; 47:324-30. [PMID: 24644313 DOI: 10.1093/ejcts/ezu100] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine whether patient sex makes a difference to in-hospital mortality and survival in patients undergoing isolated coronary artery bypass graft surgery (CABG) receiving a radial artery graft. METHODS Analysis of consecutive patients on a validated prospective cardiac surgery database was performed for patients undergoing isolated CABG. Uni- and multivariate analyses were performed for in-hospital mortality and long-term survival. A propensity analysis was also performed. RESULTS Overall mortality was 2.1% (n = 284) for all cases, n = 13 369. Median follow-up was 7.0 (interquartile range 4.1-10.1) years. Of the cases 28.2% of males (n = 384) and 29.7% of females (n = 764) had a radial artery utilized. Univariate analysis demonstrated that in-hospital mortality was significantly lower in male patients, P < 0.001, and radial artery use was associated with increased survival in males, P < 0.0001, but not in females, P = 0.82. In male patients, multivariate analysis failed to identify the radial artery as a risk factor for in-hospital death. The radial artery was identified as a significant prognostic factor, associated with improved long-term survival (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.69-0.88, P = 0.0001). Propensity analysis confirmed this finding (HR 0.76, 95% CI 0.67-0.86, P < 0.0001). In female patients, multivariate analysis failed to identify the radial artery as a significant factor determining in-hospital mortality or long-term survival. Propensity analysis confirmed these findings. CONCLUSION Males derive a significant survival advantage if they receive a radial artery graft when undergoing isolated CABG. The radial artery makes no difference to long-term survival in female patients. Radial artery use does not affect in-hospital mortality regardless of patient sex.
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Affiliation(s)
- Mark Pullan
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Aung Oo
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Matthew Shaw
- Liverpool Heart and Chest Hospital, Liverpool, UK
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Pullan M, Kirmani BH, Conley T, Oo A, Shaw M, McShane J, Poullis M. Should obese patients undergo on- or off-pump coronary artery bypass grafting? Eur J Cardiothorac Surg 2014; 47:309-15. [DOI: 10.1093/ejcts/ezu108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Warwick R, Mediratta N, Chalmers J, McShane J, Shaw M, Poullis M. Virchow’s triad and intestinal ischemia post cardiac surgery. Asian Cardiovasc Thorac Ann 2014; 22:927-34. [DOI: 10.1177/0218492314522252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intestinal ischemia is associated with a very high mortality rate. We combined the principles of Virchow’s triad to produce preoperative and postoperative models for the development of intestinal ischemia. Methods A single institutional study was undertaken involving 18,325 consecutive patients from April 1997 to March 2012. Univariate and multivariate analysis was performed. Results Mortality was 87% in 91 patients who developed bowel ischemia. Multivariate logistic regression demonstrated that age, peripheral vascular disease, intraaortic balloon pump support, female sex, and preexisting renal failure were significant determinates of intestinal ischemia preoperatively. Logistic regression demonstrated that age, peripheral vascular disease, creatine kinase-MB level, reoperation for bleeding, and blood product usage were significant determinates of intestinal ischemia postoperatively. Conclusions Potentially remedial causes of intestinal ischemia include blood product usage, reoperation for bleeding, and creatine kinase-MB release. Age, female sex, peripheral vascular disease, intraaortic balloon pump usage, and preexisting renal failure are fixed risk factors. Despite the continuing trend of reduced blood product usage in the field of cardiac surgery, the increase in patients’ risk factors will mean that incidences of intestinal ischemia may increase in the future.
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Affiliation(s)
| | | | | | | | - Matthew Shaw
- Liverpool Heart and Chest Hospital, Liverpool, UK
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Poullis M. Letter by Poullis regarding article, "Prognostic value of the index of microcirculatory resistance measured after primary percutaneous coronary intervention". Circulation 2014; 129:e341. [PMID: 24550556 DOI: 10.1161/circulationaha.113.004607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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O'Boyle F, Mediratta N, Chalmers J, Warwick R, Shaw M, McShane J, Poullis M. Long-term survival of non-smokers undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg 2013; 45:445-51. [PMID: 24031047 DOI: 10.1093/ejcts/ezt419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We sought to investigate long-term survival of non-smokers undergoing coronary artery bypass surgery (CABG). METHODS A prospective database of consecutive patients was retrospectively analysed and cross correlated with the UK strategic tracking service to evaluate survival after primary CABG. Univariate, multivariate and a propensity analyses were performed. RESULTS We analysed 13 337 primary CABG procedures. Median follow-up was 7 years. Kaplan-Meier survival curves demonstrate that non-smokers have a significantly improved long-term survival compared with ex- and current smokers, P < 0.0001. Cox regression analysis identified smoking status, age, diabetes, ejection fraction (EF), body mass index, cerebrovascular disease, dialysis, left internal mammary artery (LIMA) non-usage, postoperative creatinine kinase muscle-brain isoenzyme (CKMB), radial artery usage, preoperative rhythm, forced vital capacity (FVC) and logistic EuroSCORE as significant risk factors determining long-term survival. Propensity matching resulted in 3575 non-smokers being matched 1:1, with ex-smokers. After matching, univariate analysis demonstrated the significantly worse long-term survival of ex-smokers compared with non-smokers, P < 0.0001. Cox regression analysis identified smoking status, age, postoperative CKMB, cerebrovascular disease, dialysis, diabetes, EF, FVC, LIMA non-usage, radial artery used, sinus rhythm and logistic EuroSCORE as significant risk factors determining long-term survival. Survival by smoking status plotted at the mean of the covariates, prepropensity matching, demonstrated that non-smokers had a significantly better long-term survival than ex-smokers, P < 0.0001; however, after propensity matching, non-smokers under 65 years of age had a significantly worse long-term survival compared with ex-smokers, P < 0.0001. CONCLUSIONS Non-smokers under the age of 65 years of age have significantly worse long-term survival compared with ex-smokers after risk factor adjustment. We speculate that this is because ex-smokers have had the causative factor, smoking, removed, but non-smokers have not.
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Affiliation(s)
- Francesca O'Boyle
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Pullan M, Chalmers J, Mediratta N, Shaw M, McShane J, Poullis M. Statins and long-term survival after isolated valve surgery: the importance of valve type, position and procedure. Eur J Cardiothorac Surg 2013; 45:419-24; discussion 424-5. [PMID: 23959738 DOI: 10.1093/ejcts/ezt399] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate whether valve position, type and procedure are important factors in determining the beneficial effects of statin therapy with regard to long-term survival in patients undergoing isolated single valve surgery. METHODS A prospective single-institution cardiac surgery database was analysed. Univariate, multivariate stepwise linear, logistic and Cox regression analysis and propensity matching were performed to identify if statins were associated with increased survival post-valve surgery. RESULTS Overall mortality was 3.4% (n = 172) for all cases, n = 5013. The median follow-up was 5.8 years. Kaplan-Meier survival analysis indicated that statin therapy was beneficial for all patients undergoing isolated valve surgery, n = 5013, P = 0.03 and isolated aortic valve surgery, n = 3220, P = 0.03, but not isolated mitral valve surgery n = 1793, P = 0.4. Cox regression analysis of the study cohort revealed that statin therapy was a significant factors determining long-term survival in the study cohort, postisolated aortic valve replacement and postisolated biological aortic valve replacement. Statins therapy was not associated with an increased long-term survival post-mitral valve replacement or repair. Propensity matching resulted in 1555 patients receiving statins being matched 1:1 with those not receiving statins. The results after propensity matching concurred with that of the Cox regression analyses, demonstrating that statin therapy was significantly associated with reduced in-hospital mortality, hospital length of stay and postoperative creatinine kinase, muscle-brain isoenzyme release. CONCLUSIONS Previous publications have not distinguished valve type, position and repair as possible factors influencing statin-therapy outcomes. Statin therapy is associated with increased long-term survival postaortic valve replacement with a biological valve only. Statin therapy had no survival benefit in patients undergoing mitral valve repair or a mechanical valve replacement. A randomized trial is necessary to confirm or refute our findings.
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Affiliation(s)
- Mark Pullan
- Liverpool Heart and Chest Hospital, Liverpool, UK
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