ABSTRACT: We evaluated the impact of aortic cross-clamping time (XCT) and cardiopulmonary bypass time (CPBT) on the immediate and late outcome after adult cardiac surgery and attempted to identify their safe time limits.
This study includes 3280 patients who underwent adult cardiac surgery of various complexities. Myocardial protection was achieved with tepid continuous antegrade/retrograde blood cardioplegia.
Receiver operating characteristics (ROC) curve analysis showed that XCT (area under the curve, AUC: 0.66), CPBT (AUC: 0.73) and CPBT with unclamped aorta (AUC: 0.77) were significantly associated with 30-day postoperative mortality. XCT of increasing 30-minute intervals (Odds Ratio (OR) 1.21, 95%C.I. 1.01-1.52) and CPBT of increasing 30-minute intervals (OR 1.47, 95%C.I. 1.27-1.71) were independent predictors of 30-day mortality. The best cutoff value for XCT was 150 min (30-day death: 1.8% vs. 12.2%, adjusted OR 3.07, 95%C.I. 1.48-6.39, accuracy 91.5%) and for CPBT 240 min (30-day death: 1.9% vs. 31.5%, adjusted OR 8.78, 95%C.I. 4.64-16.61, accuracy 96.0%). These parameters were significantly associated also with postoperative morbidity, particularly with postoperative stroke.
XCT and CPBT are predictors of immediate postoperative morbidity and mortality. In our experience, cardiac procedures with CPBT<240 min and XCT<150 min were associated with a rather low risk of immediate postoperative adverse events independently of the complexity of surgery patient's operative risk.
Perfusion 12/2009; 24(5):297-305. · 0.92 Impact Factor
ABSTRACT: We derived a new risk-scoring method by modifying some of the risk factors included in the EuroSCORE algorithm.
This study includes 3613 patients who underwent cardiac surgery at the Vaasa Central Hospital, Finland. The EuroSCORE variables, along with modified age classes (< 60 years, 60-69.9 years, 70-79.9 years and > or = 80 years), eGFR-based chronic kidney disease classes (classes 1-2, class 3 and classes 4-5) and the number of cardiac procedures, were entered into the regression analysis.
An additive risk score was calculated according to the results of logistic regression by adding the risk of the following variables: patients' age classes (0, 2, 4 and 6 points), female (2 points), pulmonary disease (3 points), extracardiac arteriopathy (2 points), neurological dysfunction (4 points), redo surgery (3 points), critical preoperative status (8 points), left ventricular ejection fraction (> 50%: 0; 30-50%: 2 and < 30%: 3 points), thoracic aortic surgery (8 points), postinfarct septal rupture (9 points), chronic kidney disease classes (0, 3 and 6 points), number of procedures (1: 0; 2: 2 and 3 or more: 7 points). The modified score had a better area under the receiver operating characteristic curve (additive: 0.867; logistic: 0.873) than the EuroSCORE (additive: 0.835; logistic: 0.840) in predicting 30-day postoperative mortality. The modified score, but not EuroSCORE, correctly estimated the 30-day postoperative mortality.
EuroSCORE still performs well in identifying high-risk patients, but significantly overestimates the immediate postoperative mortality. This study shows that the score's accuracy and clinical relevance can be significantly improved by modifying a few of its variables. This institutionally derived risk-scoring method represents a modification and simplification of the EuroSCORE and, likely, it would provide a more realistic estimation of the mortality risk after adult cardiac surgery.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 07/2009; 36(5):799-804. · 2.40 Impact Factor
ABSTRACT: The study aim was to evaluate whether pulmonary function, as assessed by spirometry, affects immediate outcome after aortic valve replacement (AVR).
Data relating to the preoperative percentages of predicted forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were retrieved from a series of 453 patients who underwent AVR, with or without coronary artery bypass surgery.
The percentage of predictive FVC (odds ratio (OR) 0.952; 95% CI 0.914-0.990; AUC 0.749; p = 0.019), but not of predicted FEV1, nor any history of pulmonary disease, proved to be independent predictors of in-hospital mortality, even when adjusted for the logistic EuroSCORE. A percentage predictive FVC of < 80% proved to be the best cut-off (in-hospital mortality 6.3% versus 1.3%; p = 0.005; OR 5.100; 95% CI 1.544-16.849; specificity 69%, sensitivity 69%). The percentage of predictive FVC was found to be an independent predictor of stroke (OR 0.956; 95% CI 0.923-0.989; p = 0.009). Patients with a percentage of predictive FVC < 80% had a risk of postoperative stroke of 6.9% versus 1.9% among those patients with better FVC values (OR 3.769; 95% CI 1.342-10.581; p = 0.012). Patients with a percentage of predictive FVC < 80% (10.4% versus 4.2%; OR 2.648; 95% CI 1.225-5.724; p = 0.011) and a history of pulmonary disease (13.1% versus 5.1%; OR 2.808; 95% CI 1.117-6.694; p = 0.016) had a significantly higher risk of an intensive care unit stay of five or more days. Postoperative pneumonia was not associated with either spirometric parameters, nor with any history of pulmonary disease.
Pulmonary disease, as indicated by decreased preoperative values of FVC and FEV1, is an important comorbidity factor in patients undergoing AVR surgery. Further studies are required to demonstrate whether the identification and treatment of these patients could improve their outcome after AVR.
The Journal of heart valve disease 07/2009; 18(4):374-9. · 0.81 Impact Factor