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Khan H, Uzzaman M, Benedetto U, Butt S, Raja SG. On- or off-pump coronary artery bypass grafting for octogenarians: A meta-analysis of comparative studies involving 27,623 patients. Int J Surg 2017; 47:42-51. [PMID: 28951288 DOI: 10.1016/j.ijsu.2017.09.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/13/2017] [Accepted: 09/16/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Coronary artery bypass grafting (CABG) is being increasingly offered to octogenarians. Both on- and off-pump CABG are reported as effective surgical revascularization strategies for octogenarians by single institution studies. However, the issue of superiority of one strategy over the other for octogenarians remains unresolved due to limited sample size of these studies. A meta-analysis of studies comparing outcomes of on- and off-pump CABG in octogenarians was undertaken to address the issue. METHODS A literature search was conducted from 1966 through September 2016 using MEDLINE, EMBASE, Scopus and Web of Science to identify relevant articles. Primary outcomes of interest included in-hospital mortality and stroke. Secondary outcomes of interest were atrial fibrillation, acute renal failure, reoperation for bleeding, deep sternal wound infection, myocardial infarction, intensive therapy unit (ITU) stay and hospital stay. The random effects model was used to calculate the outcomes of both binary and continuous data to control any heterogeneity between the studies. Heterogeneity amongst the trials was determined by means of the Cochran Q value and quantified using the I2 inconsistency test. All p-values were 2-sided and a 5% level was considered significant. RESULTS Sixteen retrospective studies (18,685 on-pump patients and 8938 off-pump patients) were included in the systematic review. In-hospital mortality (pooled OR = 0.64, 95% CI = 0.44 to 0.93; p = 0.02), stroke rate (pooled OR = 0.61, 95% CI = 0.48 to 0.76; p < 0.001) and length of hospital stay (pooled WMD = +0.29, 95% CI = +0.02 to +0.56; p = 0.04) were significantly lower in the off-pump patients. Atrial fibrillation (p = 0.36), acute renal failure (p = 0.47), reoperation for bleeding (p = 0.99), deep sternal wound infection (p = 0.59), myocardial infarction (p = 0.93), and length of ITU stay (p = 0.27) were comparable. CONCLUSION Off-pump compared to on-pump CABG offers surgical myocardial revascularization to octogenarians with lower in-hospital mortality, stroke rate and length of hospital stay with similar incidence of other adverse outcomes. Preferentially offering off-pump CABG to octogenarians could translate into reduced economic burden on the healthcare providers.
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Affiliation(s)
- Habib Khan
- Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
| | - Mohsin Uzzaman
- Department of Cardiac Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Umberto Benedetto
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
| | - Salman Butt
- Department of Cardiac Surgery, Kings College Hospital, London, United Kingdom
| | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom
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Piątek J, Kędziora A, Konstanty-Kalandyk J, Kiełbasa G, Olszewska M, Song BH, Wierzbicki K, Milaniak I, Darocha T, Sobczyk D, Kapelak B. Risk factors for in-hospital mortality after coronary artery bypass grafting in patients 80 years old or older: a retrospective case-series study. PeerJ 2016; 4:e2667. [PMID: 27920951 PMCID: PMC5136134 DOI: 10.7717/peerj.2667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/08/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Age remains a significant and unmodifiable risk factor for cardiovascular diseases, and an increasing number of patients older than 80 years of age undergo Coronary Artery Bypass Grafting (CABG). Old age is also an independent risk factor for postoperative complications. The aim of this study is to describe the population of patients 80 years of age or older who underwent CABG procedure and to assess the mortality rate and risk factors for in-hospital mortality. METHODS A retrospective case-series study analyzing 388 consecutive patients aged 80 years of age or older who underwent isolated CABG procedure between 2010 and 2014 in the Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow. RESULTS In-hospital mortality stood at 7%, compared to 3.4% for all isolated CABG procedures at our Institution. In an univariate logistic regression analysis, risk factors for in-hospital mortality were as follows: NYHA class (p = 0.005, OR 1.95, 95% CI [1.23-3.1]), prolonged mechanical ventilation (p < 0.001, OR 7.08, 95% CI [2.47-20.3]), rethoracotomy (p = 0.04, OR 3.31, 95% CI [1.04-10.6]), duration of the procedure and ECC (for every 10 min p = 0.01, OR 1.01, 95% CI [1.0-1.01]; p = 0.03, OR 1.01, 95% CI [1.0-1.02], respectively), PRBC, FFP, and PLT transfusion (for every unit transfused p = 0.004, OR 1.42, 95% CI [1.12-1.8]; p = 0.002, OR 1.55, 95% CI [1.18-2.04]; p = 0.009, OR 1.93, 95% CI [1.18-3.14], respectively). Higher LVEF (p = 0.02, OR 0.97, 95% CI [0.94-0.99]) and LIMA graft implantation (p = 0.04, OR 0.36, 95% CI [0.13-0.98) decreased the in-hospital mortality. Death before discharge was more often observed in patients with multiple risk factors for cardiovascular diseases (0-2 -5.7%; 3-7.4%, 4-26.6%; p = 0.03). CONCLUSIONS Older age is associated with higher in-hospital mortality after isolated CABG at our Institution. Risk stratification scores and individualized risk evaluation, centered on comorbidities, NYHA class and left ventricular function, should be assessed in all cases. Whenever suitable, LIMA grafts should be used. Prolonged procedure and ECC time worsen the short-term outcome. Elderly individuals should be closely monitored postoperatively and the care should be focused on excessive blood loss and respiratory failure.
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Affiliation(s)
- Jacek Piątek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Anna Kędziora
- Cardiosurgical Students' Scientific Group, Jagiellonian University Medical College , Krakow , Poland
| | - Janusz Konstanty-Kalandyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College , Krakow , Poland
| | - Marta Olszewska
- Cardiosurgical Students' Scientific Group, Jagiellonian University Medical College , Krakow , Poland
| | - Bryan HyoChan Song
- Cardiosurgical Students' Scientific Group, Jagiellonian University Medical College , Krakow , Poland
| | - Karol Wierzbicki
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Irena Milaniak
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Tomasz Darocha
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Anesthesiology and Intensive Care, John Paul II Hospital, Krakow, Poland
| | - Dorota Sobczyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Admission and Emergency Department, John Paul II Hospital, Krakow, Poland
| | - Bogusław Kapelak
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
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Itoh S, Kimura N, Adachi H, Yamaguchi A. Is Bilateral Internal Mammary Arterial Grafting Beneficial for Patients Aged 75 Years or Older? Circ J 2016; 80:1756-63. [PMID: 27334306 DOI: 10.1253/circj.cj-16-0181] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although bilateral internal mammary artery (BIMA) grafting is performed with increasing regularity in elderly patients, whether it is truly beneficial, and therefore indicated, in these patients remains uncertain. We retrospectively investigated early and late outcomes of BIMA grafting in patients aged ≥75 years. METHODS AND RESULTS We identified 460 patients aged ≥75 years from among 2,618 patients who underwent either single internal mammary artery (SIMA) grafting (n=293) or BIMA grafting (n=107). Early outcomes did not differ between the SIMA and BIMA patients (30-day mortality: 1.7% vs. 0%, P=0.39; sternal wound infection: 1.0% vs. 4.7%; P=0.057). Late outcomes, 10-year survival in particular, were improved in the BIMA group (36.6% vs. 48.1%, P=0.033). In the analysis of the results in propensity score-matched groups (196 patients in the SIMA group, 98 patients in the BIMA group), improved 10-year survival was documented in the BIMA group (34.8% vs. 47.6%, P=0.030). Cox proportional regression analysis showed SIMA usage (non-use of BIMA) to be a predictor for late mortality (hazard ratio: 0.65, 95% confidence interval: 0.43-0.98, P=0.042). We further compared outcomes between the total non-elderly patients (n=2,158) and total elderly patients (n=460). BIMA usage was similar, as was 30-day mortality (1.0% vs. 1.3%, respectively). CONCLUSIONS A survival advantage, with no increase in early mortality, can be expected from BIMA grafting in patients aged ≥75 years. (Circ J 2016; 80: 1756-1763).
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Affiliation(s)
- Satoshi Itoh
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University
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Rozanova J, Noulas P, Southwick SM, Pietrzak RH. Perceptions of Determinants of Successful Aging Among Older U.S. Veterans: Results from the National Health and Resilience in Veterans Study. Am J Geriatr Psychiatry 2015; 23:744-53. [PMID: 25488494 DOI: 10.1016/j.jagp.2014.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 08/26/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To conduct a qualitative study of older American veterans' subjective perceptions of factors that contribute to successful physical, emotional, and cognitive aging. METHODS A nationally representative sample of 2,025 veterans aged 60 or older (range: 60-96; 96.9% male, 39.4% combat veterans) participated in the National Health and Resilience in Veterans Study. Using qualitative analysis software, the authors coded responses to three open-ended questions, inductively developed categories, aggregated similar categories into factors, and grouped factors into broader themes. RESULTS A total of 53, 56, and 61 categories of responses was identified in response to questions about successful physical, cognitive, and emotional aging, respectively, with 10 aggregate factors linking these categories. The most prominent theme overall was "What you do," which received 2,295, 2,210, and 1,247 mentions for each of these domains of successful aging, with health behaviors the most common factor for both successful physical and cognitive aging and social engagement the most common for successful emotional aging. The theme "Who you are" was the second-most common factor (discerned from 376, 247, and 943 total mentions, respectively), with the factors that comprise this theme-personality and explanatory style, moral compass, and emotional dispositions-more commonly endorsed for successful emotional aging. External factors such as healthcare were least commonly endorsed across all domains. CONCLUSION Older U.S. Veterans emphasize health behaviors, social engagement, and dispositional characteristics as key determinants of successful aging. Prevention and treatment initiatives that target these potentially modifiable factors may help promote successful aging in this growing segment of the population.
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Affiliation(s)
- Julia Rozanova
- Department of Sociology, Yale University, New Haven, CT.
| | - Paraskevi Noulas
- VA Connecticut Healthcare System and Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Steven M Southwick
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder and Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder and Department of Psychiatry, Yale School of Medicine, New Haven, CT
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Grothusen C, Attmann T, Friedrich C, Freitag-Wolf S, Haake N, Cremer J, Schöttler J. Predictors for long-term outcome and quality of life of patients after cardiac surgery with prolonged intensive care unit stay. Interv Med Appl Sci 2013; 5:3-9. [PMID: 24265881 DOI: 10.1556/imas.5.2013.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 11/26/2012] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This study investigated factors determining the long-term outcome and quality of life of patients with a prolonged intensive care unit (ICU) stay after cardiac surgery. DESIGN A retrospective analysis was performed in 230 patients that had undergone cardiac surgery and suffered from a post-operative ICU stay of 7 or more days at our institution. Among 11 pre-, 13 intra-, and 14 post-operative variables, factors influencing 5-year outcome were identified by logistic regression analysis. Quality of life was determined using the Short Form-36 questionnaire. RESULTS In-hospital mortality was 12%. One hundred and eleven of 187 patients (59%) were alive after 5 years. Non-survivors were older (70 vs. 65 years, p = 0.005) and had a higher additive EuroSCORE (7 vs. 5, p = 0.034). Logistic regression identified pre-operative atrial fibrillation (AF), (28 vs. 10%, p = 0.003) as the strongest predictor for a 5-year outcome, followed by myocardial infarction (62 vs. 41%, p = 0.005), and prolonged mechanical ventilation (8 vs. 5 days, p = 0.036). Survivors did not show an impaired physical component summary SF-36 score (39 vs. 46, p = 0.737) or mental component summary score (55 vs. 55, p = 0.947) compared to an age-matched German Normative Sample. CONCLUSIONS Pre-operative AF proved to be the most important factor determining the 5-year outcome of patients with a prolonged ICU stay after cardiac surgery. Neither physical nor mental health appeared to be impaired in these patients.
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Sanders J, Keogh BE, Van der Meulen J, Browne JP, Treasure T, Mythen MG, Montgomery HE. The development of a postoperative morbidity score to assess total morbidity burden after cardiac surgery. J Clin Epidemiol 2012; 65:423-33. [PMID: 22360990 DOI: 10.1016/j.jclinepi.2011.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 10/15/2011] [Accepted: 11/15/2011] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To develop a tool for identifying and quantifying morbidity following cardiac surgery (cardiac postoperative morbidity score [C-POMS]). STUDY DESIGN AND SETTING Morbidity was prospectively assessed in 450 cardiac surgery patients on postoperative days 1, 3, 5, 8, and 15 using POMS criteria (nine postoperative morbidity domains in general surgical patients) and cardiac-specific variables (from expert panel). Other morbidities were noted as free text and included if prevalence was more than 5%, missingness less than 5%, and mean expert-rated severity-importance index score more than 8. Construct validity was assessed by expert panel review, Cronbach's alpha (internal consistency), and linear regression (predictive ability of C-POMS for length of stay [LOS]). RESULTS A 13-domain model was derived. Internal consistency (>0.7) on D3-D15 permits use as a summative score of total morbidity burden. Mean C-POMS scores were 3.4 (D3), 2.6 (D5), 3.4 (D8), and 3.8 (D15). Patient LOS was 4.6 days (P=0.012), 5.3 days (P=0.001), and 7.6 days (P=0.135) longer in patients with C-POMS-defined morbidity on D3, D5, D8, and D15, respectively, than in those without. For every unit increase in C-POMS summary score, subsequent LOS increased by 1.7 (D3), 2.2 (D5), 4.5 (D8), and 6.2 (D15) days (all P=0.000). CONCLUSION C-POMS is the first validated tool for identifying total morbidity burden after cardiac surgery. However, further external validation is warranted.
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Affiliation(s)
- Julie Sanders
- Institute for Human Health and Performance, University College London, 74 Huntley Street, London, UK.
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Al-Alao BS, Parissis H, McGovern E, Tolan M, Young VK. Propensity analysis of outcome in coronary artery bypass graft surgery patients >75 years old. Gen Thorac Cardiovasc Surg 2012; 60:217-24. [DOI: 10.1007/s11748-011-0875-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 08/08/2011] [Indexed: 11/29/2022]
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Elfstrom KM, Hatefi D, Kilgo PD, Puskas JD, Thourani VH, Guyton RA, Halkos ME. What happens after discharge? An analysis of long-term survival in cardiac surgical patients requiring prolonged intensive care. J Card Surg 2011; 27:13-9. [PMID: 22150640 DOI: 10.1111/j.1540-8191.2011.01341.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac surgical patients with postoperative complications frequently require prolonged intensive care yet survive to hospital discharge. METHODS From January 1, 2002 to December 31, 2007, 11,541 consecutive patients underwent cardiac operations at a single academic institution. Of these, 11,084 (95.9%) survived to hospital discharge and comprised the study sample. Patients were retrospectively categorized into four groups according to intensive care unit (ICU) length of stay (LOS): <3 days, three to seven days, 7 to 14 days, and >14 days. Survival at 12 months was determined using the Social Security Death Index. Kaplan-Meier (KM) survival curves and Cox proportional hazards regression modeling (hazard ratio, HR) were used to analyze group differences in survival. RESULTS One-year survival among the four groups according to ICU LOS was: <3 days, 97.0% (8407/8666); three to seven days, 91.2% (1481/1625); 7 to 14 days, 87.9% (356/405); and >14 days, 68.3% (265/388) (p < 0.001). Using multivariable regression analysis, adjusted overall mortality was significantly greater in patients with ICU LOS of three to seven days (HR = 1.51), 7 to 14 days (HR = 1.40), and >14 days (HR = 1.90) compared to patients with ICU LOS <3 days. Mortality among patients who survived more than six months postsurgery was significantly greater in patients with ICU LOS of three to seven days (HR = 1.37), 7 to 14 days (HR = 1.34), and >14 days (HR = 1.63). CONCLUSIONS Although cardiac surgery patients with major postoperative complications frequently survive to hospital discharge, survival after discharge is significantly reduced in patients requiring prolonged ICU care. Reduced survival in patients with a high risk of complications and anticipated long ICU stays should be considered when discussing surgical versus nonsurgical options.
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Affiliation(s)
- K Miriam Elfstrom
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Mächler H, Salaymeh L, Zirngast B, Anelli-Monti M, Oberwalder P, Yates A, Knez I, Huber S, Streinu C, Ovcina I, Malliga D, Keeling I, Beran E, Mircic A, Meszaros K, Hetterle R, Rieger K, Curcic P, Vötsch A, Marte W, Toller W, Quehenberger F, Dacar D. There is no significant difference in the operative risk between octogenarians compared with patients younger than 60 years in cardiac surgery*. Eur Surg 2011. [DOI: 10.1007/s10353-011-0054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e123-210. [PMID: 22070836 DOI: 10.1016/j.jacc.2011.08.009] [Citation(s) in RCA: 575] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:e652-735. [PMID: 22064599 DOI: 10.1161/cir.0b013e31823c074e] [Citation(s) in RCA: 390] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Ranucci M, Ballotta A, Castelvecchio S, De Vincentiis C, Biondi A, Parisi A, Menicanti L, Frigiola A. Perioperative heart failure in coronary surgery and timing of intra-aortic balloon pump insertion. Acta Anaesthesiol Scand 2010; 54:878-84. [PMID: 20528777 DOI: 10.1111/j.1399-6576.2010.02252.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Perioperative heart failure (HF) in coronary operations is accompanied by a high operative mortality rate. An intra-aortic balloon pump (IABP) is often used to treat this syndrome. The correct timing for IABP insertion after completion of the operation has not yet been investigated. The aim of this study was to investigate the operative mortality in perioperative HF patients who had undergone coronary operations with respect to the early or the late use of IABP. METHODS This is a retrospective study including 7,270 patients who had undergone coronary surgery with or without associated procedures. A population of patients with perioperative HF was extracted and analyzed with respect to the use of drugs, intra-operative or post-operative IABP to treat this condition. RESULTS A total of 1,051 (14.5%) patients had perioperative HF. The mortality rate in this group was 13.5%. Early (intra-operative) IABP insertion was performed in 123 patients. In contrast, 928 patients were treated with inotropic drugs only, and, of these patients, 59 developed a drug-refractory HF requiring late IABP insertion. Operative mortality was significantly (P=0.001) higher in patients requiring late (64.4%) vs. early (41.5%) IABP insertion. Independent risk factors for developing a drug-refractory HF were age, pre-operative serum creatinine value and an associated mitral valve procedure. CONCLUSIONS Postponing the use of IABP may be deleterious in patients with drug-refractory HF. In the presence of the three factors independently associated with the risk of a drug-refractory HF, early IABP insertion is suggested.
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Affiliation(s)
- M Ranucci
- Department of Cardiothoracic - Vascular Anesthesia and Intensive Care, IRCCS Policlinico S.Donato, Milan, Italy.
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