-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVES
Preoperative atrial fibrillation (PAF) has been associated with poorer early and mid-term outcomes after isolated valvular or coronary artery bypass graft surgery. Few studies, however, have evaluated the impact of PAF on early and mid-term outcomes after concomitant aortic valve replacement and coronary aortic bypass graft (AVR-CABG) surgery.METHODS
Data obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program was retrospectively analysed. Patients who underwent concomitant atrial arrhythmia surgery/ablation were excluded. Demographic and operative data were compared between patients undergoing concomitant AVR-CABG who presented with PAF and those who did not using chi-square and t-tests. The independent impact of PAF on 12 short-term complications and mid-term mortality was determined using binary logistic and Cox regression, respectively.RESULTSConcomitant AVR-CABG surgery was performed in 2563 patients; 322 (12.6%) presented with PAF. PAF patients were generally older (mean age 76 vs 74 years; P < 0.001) and presented more often with comorbidities including congestive heart failure, chronic pulmonary disease and cerebrovascular disease (all P < 0.05). PAF was associated with 30-day mortality on univariate analysis (P = 0.019) but not multivariate analysis (P = 0.53). The incidence of early complications was not significantly higher in the PAF group. PAF was independently associated with reduced mid-term survival (HR, 1.58; 95% CI, 1.14-2.19; P = 0.006).CONCLUSIONSPAF is associated with reduced mid-term survival after concomitant AVR-CABG surgery. Patients with PAF undergoing AVR-CABG should be considered for a concomitant surgical ablation procedure.
Interactive cardiovascular and thoracic surgery 01/2013;
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: No previous studies have specifically addressed the effect of training on outcomes after concomitant aortic valve replacement and coronary artery bypass grafting. This study evaluated the early and late outcomes after concomitant aortic valve replacement and coronary artery bypass grafting performed by surgeons in training. METHODS: A retrospective analysis of data collected prospectively by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database between June 2001 and December 2009 was performed. Concomitant aortic valve replacement and coronary artery bypass grafting was performed in 2540 patients; of these procedures, 290 (11.4%) were by trainees. Patient demographics, intraoperative characteristics, and early morbidity were compared between trainee and staff cases using chi-square analysis and t tests. Multivariate analyses were used to determine the independent association of training status with 30-day and late mortality. RESULTS: Compared with staff cases, trainee cases were younger (mean age, 73.0 vs 74.2 years; P = .025) and less likely to present with triple vessel disease (27.9% vs 38.3%, P = .001) or previous cardiac surgery (6.3% vs 2.8%, P = .016). Trainee cases had longer mean perfusion (160.4 vs 144.6 minutes, P < .001) and crossclamp (125.2 vs 114.6 minutes, P < .001) times. The incidence of early complications was similar between the 2 groups. On multivariate analysis, trainee status was not associated with an increased risk of 30-day mortality (2.4% vs 4.0%, P = .348). Moreover, there was no significant difference in long-term outcomes, and 5-year survival was comparable in both groups (79.6% vs 77.4%, P = .200). CONCLUSIONS: Concomitant aortic valve replacement and coronary artery bypass grafting can be safely and effectively performed by properly supervised trainees in the contemporary era. It is imperative to offer training opportunities to junior surgeons in this complex procedure to ensure quality patient outcomes in the future.
The Journal of thoracic and cardiovascular surgery 10/2012; · 3.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Women undergoing isolated coronary artery bypass graft (CABG) surgery have been previously shown to be at an independently increased risk for post-operative morbidity and mortality. The current study evaluates the impact of sex as an independent risk factor for early and late morbidity and mortality following isolated CABG surgery.
Data obtained between June 2001 and December 2009 by the Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program was retrospectively analysed. Demographic, operative data and post-operative complications were compared between male and female patients using chi-square and t-tests. Long-term survival analysis was performed using Kaplan-Meier survival curves and the log-rank test. Independent risk factors for short- and long-term mortality were identified using binary logistic and Cox regression, respectively.
CABG surgery was undertaken in 21 534 patients at 18 Australian institutions; 22.2% were female. Female patients were generally older (mean age, 68 vs. 65 years, P < 0.001) and presented more often with congestive heart failure (P < 0.001), hypertension (P < 0.001), diabetes mellitus (P < 0.001) and cerebrovascular disease (P < 0.001). Women demonstrated a greater 30-day mortality (2.2% vs. 1.5%, P < 0.001) on univariate analysis but not on multivariate analysis (P = 0.638). Similarly, women demonstrated a greater late mortality than men on univariate analysis (P = 0.006) but not on multivariate analysis (P = 0.093). Women had a decreased risk of early complications including new renal failure (P = 0.001) and deep sternal wound infection (P = 0.017) but were more likely to require red blood cell transfusion (P < 0.001).
Female patients undergoing isolated CABG surgery have a greater 30-day mortality which may be accounted for by a poorer pre-operative risk factor profile. Further investigation is required into the reasons for differential outcome after CABG based on sex.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 04/2012; 41(4):755-62. · 2.40 Impact Factor
-
Journal of the American Geriatrics Society 09/2011; 59(9):1759-61. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To develop a multivariable logistic risk model for predicting early mortality following aortic valve replacement (AVR) in adults, and to compare its performance against existing AVR-dedicated models.
Prospectively collected data from the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) database project were used. Thirty-five preoperative variables from AVR literature were considered for analysis by chi-square method and multiple logistic regression. Using the bootstrap re-sampling technique for variable selection, five plausible models were identified. Based on models' calibration, discrimination and predictive capacity during n-fold validation, a final model, the AVR-Score, was chosen. An additive score, derived from the final model, was also validated externally in a consecutive cohort. The performance of AVR-dedicated risk models from the North West Quality Improvement Program (NWQIP) and the Northern New England Cardiovascular Study (NNE) groups were also assessed using the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow (H-L) chi-square test.
Between July 2001 and June 2008, a total of 3544 AVR procedures were performed. Early mortality was 4.15%. The AVR-Score contained the following predictors: age, New York Heart Association class, left main disease, infective endocarditis, cerebrovascular disease, renal dysfunction, previous cardiac surgery and estimated ejection fraction. Our final model (AVR-Score) obtained an average area under ROC curve of 0.78 (95% confidence interval (CI): 0.76, 0.80) and an H-L p-value of 0.41 (p>0.05) during internal validation, indicating good discrimination and calibration capacity. External validation of the additive score on a consecutive cohort of 1268 procedures produced an ROC of 0.73 (0.62, 0.84) and an H-L p-value of 0.48 (p>0.05). The NWQIP and NNE risk models achieved acceptable discrimination of ROC of 0.77 (0.73, 0.81). However, both models obtained H-L p-values of 0.002 (p<0.05), indicating a poor fit in our cohort.
Existing AVR-dedicated risk models were deemed inappropriate for risk prediction in the Australian population. A preoperative risk model was developed using prospective data from a contemporary AVR cohort.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2011; 39(6):815-21. · 2.40 Impact Factor
-
Nick Andrianopoulos, Diem Dinh,
Stephen J Duffy,
David J Clark,
Angela L Brennan,
William Chan,
Gilbert C Shardey,
Julian A Smith,
Cheng-Hon Yap,
Brian F Buxton,
Andrew E Ajani,
Christopher M Reid
[show abstract]
[hide abstract]
ABSTRACT: To describe and outline audit and quality control activities of the multicentre interventional and cardiac surgery registry in Victoria as a potential model for a national registry.
The Melbourne Interventional Group (MIG) database is a prospective multicentre registry recording consecutive percutaneous coronary interventional (PCI) procedures across eight Victorian hospitals. Similarly, the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) database captures cardiac surgical activity across six Victorian hospitals. Auditing of each registry involved systematic selection of baseline, clinical and procedural variables from 5% of procedures to examine for data integrity and mismatches.
Performance trend and data accuracy of each registry was assessed by the number of mismatches detected during the auditing process for different demographic, clinical and procedural variables and across different (de-identified) sites.
Over two auditing phases from 2004-2006 and 2007, 10 (4.3%) of variables from 3% of all PCI procedures and 15 (6.4%) variables from 5% of PCI procedures were analysed. There was 96.5% agreement during the first auditing phase of the MIG registry with an average of 0.35 mismatches per audit (CI 0.28-0.42), whereas during the second audit phase, agreement was up to 97% with 0.32 mismatches per 10 fields per audit (CI 0.25-0.40). The ASCTS database audit selected 39 (14.8%) variables from 5% of annual surgical cases across six cardiac surgical centres with an overall 96.7% agreement.
The current auditing process of these two databases is rigorous, robust and reflects a high degree of accuracy of data collected by participating hospitals.
Heart Lung & Circulation 01/2011; 20(3):180-6. · 1.20 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Our objective was to identify risk factors associated with 30-day mortality after isolated coronary artery bypass grafting in the Australian context and to develop a preoperative model for 30-day mortality risk prediction.
Preoperative risk associated with cardiac surgery can be ascertained through a variety of risk prediction models, none of which is specific to the Australian population. Recently, it was shown that the widely used EuroSCORE model validated poorly for an Australian cohort. Hence, a valid model is required to appropriately guide surgeons and patients in assessing preoperative risk.
Data from the Australasian Society of Cardiac and Thoracic Surgeons database project was used. All patients undergoing isolated coronary artery bypass grafting between July 2001 and June 2005 were included for analysis. The data were divided into creation and validation sets. The data in the creation set was used to develop the model and then the model was validated in the validation set. Preoperative variables with a P value of less than .25 in chi(2) analysis were entered into multiple logistic regression analysis to develop a preoperative predictive model. Bootstrap and backward elimination methods were used to identify variables that are truly independent predictors of mortality, and 6 candidate models were identified. The Akaike Information Criteria (AIC) and prediction mean square error were used to select the final model (AusSCORE) from this group of candidate models. The AusSCORE model was then validated by average receiver operating characteristic, the P value for the Hosmer-Lemeshow goodness-of-fit test, and prediction mean square error obtained from n-fold validation.
Over the 4-year period, 11,823 patients underwent cardiac surgery, of whom 65.9% (7709) had isolated coronary bypass procedures. The 30-day mortality rate for this group was 1.74% (134/7709). Factors selected as independent predictors in the preoperative isolated coronary bypass AusSCORE model were as follows: age, New York Heart Association class, ejection fraction estimate, urgency of procedure, previous cardiac surgery, hypercholesterolemia (lipid-lowering treatment), peripheral vascular disease, and cardiogenic shock. The average area under the receiver operating characteristic was 0.834, the P value for the Hosmer-Lemeshow chi(2) test statistic was 0.2415, and the prediction mean square error was 0.01869.
We have developed a preoperative 30-day mortality risk prediction model for isolated coronary artery bypass grafting for the Australian cohort.
The Journal of thoracic and cardiovascular surgery 06/2009; 138(4):904-10. · 3.41 Impact Factor
-
Bryan P Yan,
David J Clark,
Brian Buxton,
Andrew E Ajani,
Julian A Smith,
Stephen J Duffy,
Gil C Shardey,
Peter D Skillington,
Omar Farouque,
Michael Yii,
Cheng-Hon Yap,
Nick Andrianopoulos,
Angela Brennan, Diem Dinh,
Christopher M Reid
[show abstract]
[hide abstract]
ABSTRACT: Controversy continues over the optimal revascularisation strategy for patients with multi-vessel coronary artery disease. Clinical characteristics, risk profile, and mortality of patients undergoing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are thought to differ but there are limited contemporary comparative data.
We compared clinical characteristics, in-hospital and 30-day mortality of 3841 consecutive patients undergoing isolated CABG and 4417 undergoing PCI. Independent predictors of 30-day mortality were determined by multiple logistic regression analysis.
CABG patients were older (p<0.01). The CABG group had a higher incidence of diabetes, heart failure, left ventricular ejection fraction <45%, multi-vessel coronary artery, peripheral vascular and cerebro-vascular disease (all p<0.01). Patients undergoing PCI had a higher incidence of recent myocardial infarction (MI) as the indication for revascularisation (p<0.01). In-hospital and 30-day mortality was 1.8% and 1.7% in the CABG group, and 1.4% and 1.8% in the PCI group, respectively. Independent predictors of 30-day mortality after CABG were age (odds ratio 1.1 per year, 95% confidence interval 1.0-1.1), cardiogenic shock (4.10, 1.7-10.5) and previous CABG (6.6, 2.4-17.7). Predictors after PCI were diabetes (2.7, 1.4-5.1), female gender (3.0, 1.6-5.5), renal failure (3.2, 1.2-8.0), MI<24h (4.0, 2.2-7.6), left main intervention (5.4, 1.0-27.7), heart failure (6.0, 2.6-14.0) and cardiogenic shock (11.7, 5.4-25.2).
In contemporary clinical practice, CABG is preferred in patients with multi-vessel coronary and associated non-coronary vascular disease, while PCI is the dominant strategy for acute MI. Despite this, in-hospital and 30-day mortality rates were similar. Predictors of early mortality after CABG differ to those of PCI.
Heart Lung & Circulation 03/2009; 18(3):184-90. · 1.20 Impact Factor
