[Show abstract][Hide abstract] ABSTRACT: Clinical evidence in coronary surgery is usually derived from retrospective, single institutional series. This may introduce significant biases in the analysis of critical issues in the treatment of these patients. In order to avoid such methodological limitations, we planned a European multicenter, prospective study on coronary artery bypass grafting, the E-CABG registry.
The E-CABG registry is a multicenter study and its data are prospectively collected from 13 centers of cardiac surgery in university and community hospitals located in six European countries (England, Italy, Finland, France, Germany, Sweden). Data on major and minor immediate postoperative adverse events will be collected. Data on late all-cause mortality, stroke, myocardial infarction and repeat revascularization will be collected during a 10-year follow-up period. These investigators provided a score from 0 to 10 for any major postoperative adverse events and their rounded medians were used to stratify the severity of these complications in four grades. The sum of these scores for each complication/intervention occurring after coronary artery bypass grafting will be used as an additive score for further stratification of the prognostic importance of these events.
The E-CABG registry is expected to provide valuable data for identification of risk factors and treatment strategies associated with suboptimal outcome. These information may improve the safety and durability of coronary artery bypass grafting. The proposed classification of postoperative complications may become a valuable research tool to stratify the impact of such complications on the outcome of these patients and evaluate the burden of resources needed for their treatment.
Journal of Cardiothoracic Surgery 06/2015; 10(1):90. DOI:10.1186/s13019-015-0292-z · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute kidney injury (AKI) is a vexing complication of cardiac surgery. Since exposure to contrast agents is a relevant contributing factor in the development of postoperative AKI, the optimal timing between cardiac catheterization and surgery is decisive.
A total of 2504 consecutive nonemergent patients undergoing isolated coronary artery bypass grafting (CABG), valve surgery (with or without concomitant CABG), and proximal aortic procedures were enrolled. AKI was defined by consensus RIFLE (Risk, Injury, Failure, Loss of function, End-stage renal disease) criteria. The association of postoperative AKI and time between cardiac catheterization and operation was evaluated using multivariable logistic regression modeling and propensity-matched analysis.
Postoperative AKI occurred in 230 (9%) patients. The median number of days from cardiac catheterization to operation was 5 (25th to 75th percentile: 2 to 10). The incidence of AKI was significantly higher in patients operated on ≤1day after cardiac catheterization compared to those operated on >1day after (13% vs. 8%, p=0.004). The time interval between cardiac catheterization and surgery (tested both as a continuous and a categorical variable) was not an independent AKI predictor in the propensity-matched population or the pre-matched one. Contrast exposure ≤1day before surgery was independently associated with postoperative AKI in patients undergoing valve surgery with concomitant CABG only (post-matched: OR 3.68, 95%CI 1.30 to 10.39, p=0.014).
Delaying cardiac surgery beyond 24h of exposure to contrast agents seems to be justified only in patients undergoing valve surgery with concomitant CABG.
International journal of cardiology 02/2014; 173(1). DOI:10.1016/j.ijcard.2014.02.010 · 4.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Delirium after cardiac operations is associated with significant morbidity and death. Statins have been recently suggested to exert protective cerebral effects. This study investigated whether preoperative statins were associated with decreased incidence of postoperative delirium in patients undergoing coronary artery bypass grafting.
The study enrolled 4,659 consecutive patients (21% women; age, 67.8±9.2 years) undergoing coronary artery bypass grafting. A propensity score-based optimal-matching algorithm was used to match 1,577 patients receiving preoperative statins with a control group (1:1). Patients were screened for delirium in the intensive care unit according to the Confusion Assessment Method for the intensive care unit.
Delirium affected 89 patients (3%), and preoperative statin administration was not multivariably associated with a decreased incidence of delirium (odds ratio, 1.52; 95% confidence interval, 0.97 to 2.37; p=0.18) and was also unrelated to a delirium decrease in patient subgroups undergoing isolated coronary artery bypass grafting (odds ratio, 1.31; 95% confidence interval, 0.68 to 2.52; p=0.51) or combined valvular procedures (odds ratio, 1.72; 95% confidence interval, 0.96 to 3.07, p=0.08). Similar results were observed for age groups and cardiopulmonary bypass durations. Patients affected by postoperative delirium experienced a longer hospital stay (25th to 75th percentile) of 11 (7 to 18 days) vs 7 days (7 to 8 days, p<0.001) and 12% hospital mortality vs 1% (p<0.001).
Preoperative statins were not associated with a decreased incidence of delirium in patients undergoing coronary revascularization.
The Annals of thoracic surgery 05/2012; 93(5):1439-47. DOI:10.1016/j.athoracsur.2012.02.012 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute kidney injury (AKI) following cardiac surgery is a continuing source of morbidity and mortality. Although several studies have attempted to determine its etiology and prophylactic measures, limited data exist after thoracic aortic surgery. The aim of this study was to evaluate the incidence and predictors of AKI in patients undergoing aortic root replacement (ARR) with valve conduit for ascending aorta aneurysms. A multi-center observational study of 414 patients undergoing ARR with a valve conduit was conducted, focusing on clinical outcome and AKI defined by consensus RIFLE (risk, injury, failure, loss of function, end-stage renal disease) criteria. Mean age was 62.5 years (range: 21-82 years) with 327 males (79%). Emergent operations were performed in 5% of the cases, while concomitant surgical procedures were performed in 24.9%. Postoperative AKI (all RIFLE classes) occurred in 69 (16.7%) patients, while eight (1.9%) required dialysis. Independent AKI predictors were packed red blood cells (pRBCs) >4 units (OR 2.28; 95% CI 1.20-4.30), cardiopulmonary bypass (CPB) time longer than 180 min (OR, 2.08; 95% CI, 1.16-3.73), and concomitant surgical procedures (OR, 1.85; 95% CI, 1.04-3.29). The severity of RIFLE class was associated with longer ICU stay, hospitalization, and higher hospital mortality (p < 0.001 for each variable). AKI after ARR operations with valve conduit for ascending aorta aneurysms increases utilization of health resources and is associated with adverse events. Concomitant surgical procedures, prolonged CPB-time, and pRBCs >4 units as independent AKI predictors merit further researches enhancing possible preventive strategies.
Heart and Vessels 03/2012; 28(2). DOI:10.1007/s00380-012-0239-4 · 2.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The optimal time delay between last clopidogrel dose and surgery is controversial. The aim of the present study was to analyze the impact of preoperative clopidogrel on the need for blood transfusions with reference to the proper timing of discontinuation.
Between January 2005 and December 2010, 1,947 consecutive patients undergoing coronary surgery were enrolled. Of these, 255 patients receiving preoperative clopidogrel were matched to a control group by propensity score analysis. Clopidogrel discontinuation interval before surgery was examined in 1-day increments from 0 to 5 days and >5 days. Patients who discontinued clopidogrel within 5 days of surgery accounted for 91% (211/255). Clopidogrel stop within 5 days before surgery was independently associated with transfusion requirement (P=0.001). Preoperative clopidogrel was not associated with an increased risk of hemorrhagic complications (P=0.696). No differences were observed between patients taking clopidogrel and those not taking clopidogrel with regard to hospital resource utilization and mortality. Patients receiving clopidogrel in association with aspirin did not have an additive risk for transfusion or hemorrhagic complications compared with those on clopidogrel alone (odds ratio [OR], 1.25; 95% confidence interval [CI]: 0.77-2.03; OR, 1.02; 95%CI: 0.38-2.79, respectively).
Clopidogrel administration in the 5 days preceding coronary surgery was an independent predictor for increased transfusion requirements, supporting the discontinuation of clopidogrel >5 days before surgery.
[Show abstract][Hide abstract] ABSTRACT: Acute kidney injury (AKI) occurs in as many as 40% of patients after cardiac surgery and requires dialysis in 1% of cases. Acute kidney injury is associated with an increased risk of mortality and morbidity, predisposes patients to a longer hospitalization, requires additional treatments, and increases the hospital costs. Acute kidney injury is characterized by a progressive worsening course, being the consequence of an interplay of different pathophysiologic mechanisms, with patient-related factors and cardiopulmonary bypass as major causes. Recently, several novel biomarkers have emerged, showing reasonable sensitivity and specificity for AKI prediction and protection. The development and implementation of potentially protective therapies for AKI remains essential, especially for the relevant impact of AKI on early and late survival.
The Annals of thoracic surgery 08/2011; 92(4):1539-47. DOI:10.1016/j.athoracsur.2011.04.123 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Papillary fibroelastomas are rare benign cardiac tumors. Although they have minimal hemodynamic effects, their propensity for embolization can result in serious morbidity. The pathophysiology and management of these tumors is the subject of this review.
Journal of Cardiac Surgery 02/2010; 25(2):198-205. DOI:10.1111/j.1540-8191.2009.00993.x · 0.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The manuscript is a "Letter to the Editor" concerning the paper: "Ozaydin M, Dede O, Varol E, et al. Effect of renin-angiotensin aldosteron system blockers on postoperative atrial fibrillation. Int J Cardiol 2008; 127: 362-367".
International journal of cardiology 01/2009; 142(2):209-10. DOI:10.1016/j.ijcard.2008.11.161 · 4.04 Impact Factor