[Risk factors for operative mortality in 1,098 patients with coronary artery bypass grafting surgery: a single center report].

OBJECTIVE: To analyze the risk factors for operative mortality in 1 098 cases of coronary artery bypass grafting (CABG) procedures. METHODS: A total of 1 098 cases of CABG including 113 cases of left ventricular ejection fraction (LVEF) lower than 35% from December 1999 through December 2009 were chosen for the retrospective study. Univariate and multivariate stepwise logistic analyses were performed based on the data of the whole group to locate the mortality risk factors. RESULTS: Age, acute coronary syndrome, emergent surgery, chronic renal failure (CRF), concomitant peripheral vascular disease, LVEF ≤ 35%, left ventricular end diastolic diameter (LVEDD), moderate to severe mitral regurgitation, aneurysm of the heart wall, aortic regurgitation, mitral repair/replacement, resection of aneurysm, concomitant aortic valve replacement, peri-operative intra-aortic balloon pump (IABP), left ventricular assist device (LVAD), and off-pump CABG were the risk factors for the univariate analysis. In the further multivariate regression analysis, off-pump CABG appeared statistically as a protective factor while age, female, emergent surgery, CRF, and the peri-operative application of IABP were the risk factors correspondingly for the whole group. CONCLUSION: Age, female, emergent surgery, CRF, and the application of IABP, were the risk factors for mortality in the entire group of patients, implicating the necessity of specific and cautious management. CABG concomitant with non-cardiac surgery, concomitant with the treatment of moderate-severe mitral regurgitation and resection of heart wall aneurysm were not the risk factors for peri-operative mortality.

[Investigations of influential factors of acute renal injury after coronary artery bypass grafting].

OBJECTIVE: To investigate the incidence, correlate factors and effect on convalescent of acute kidney injury (AKI) after coronary artery bypass grafting (CABG). METHODS: Sixty-eight consecutive patients who underwent scheduled CABG were included. AKI was diagnosed according to the diagnostic criteria from expert group of AKI. The patients were divided into AKI group with AKI and control group without AKI. Difference of clinic features was contrasted between the two groups. And multivariable logistic regression modeling was used to identify the risk factors of AKI. RESULTS: AKI occurred in 27.94% patients (19/68). There was significant difference between the two groups in gender, hypertension, hyperlipemia, number of grafts, the duration of mechanic ventilation, the time of ICU and the length of stay post operation. Hypertension(Wald 3.27, P=0.07, 95% CI 0.85-53.59), number of grafts(Wald 7.67, P=0.01, 95%CI 1.48-9.73), the duration of mechanic ventilation(Wald 4.94, P=0.03, 95%CI 1.00-1.18) were risk factors of AKI in multivariable logistic regression modeling. CONCLUSION: The incidence of AKI was high (27.94%). Female, hypertension, hyperlipemia, number of grafts, the duration of mechanic ventilation were risk factors in monovariance analysis, and AKI may increase the time of ICU and the length of stay post operation. Hypertension, number of grafts, duration of mechanic ventilation were independent risk factors of AKI in multivariable logistic regression model.

[Analysis of prognosis assessment with acute physiology and chronic health evaluation III, multiple organ dysfunction score and sequential organ failure assessment for the postoperative patients in cardiovascular surgery].

OBJECTIVE: To analyze the clinical significance of the prognosis assessment with acute physiology and chronic health evaluation III (APACHEIII), multiple organ dysfunction score (MODS) and sequential organ failure assessment (SOFA) for postoperative patients in cardiovascular surgery. METHODS: Prognosis of 68 patients undergoing cardiovascular operation from February 2004 to June 2004 in our ward was assessed by APACHE III, MODS and SOFA. Then the scores were calculated and compared everyday while they stayed in Cardiac Surgery Intensive Care Unit (CSICU). RESULTS: The scores of three methods showed no significant difference from one another in the first three postoperative days, but were significantly higher than all the scores calculated just after the entrance to the CSICU (A0, M0, S0; all P<0.01). There were no differences in the changes of APACHE III, MODS and SOFA(DeltaA, DeltaM and DeltaS) in the first three postoperative days respectively, although they all showed a decreasing tendency. APACHE III scores were positively correlated with MODS although the correlation were diminishing (P<0.01 at first day but P<0.05 at third day), while they were positively correlated with SOFA only in the first two days (both P<0.01). The MODS was positively correlated with SOFA at various time points (P<0.001). The length of stay in CSICU was positive correlated with A0 and maximum of APACHEIII (Amax, P<0.05), and M0, maximum of MODS (Mmax) as well as S0, maximum of SOFA (Smax, P<0.001), respectively. CONCLUSION: For the patients who have undergone cardiovascular operation, A0 could assess the prognosis fairly precisely, but MODS and SOFA assessment seem to be better than APACHE III. Individual Smax and kinetic DeltaS might be the most suitable indexes for cardiovascular surgery.