EuroSCORE predicts immediate and late outcome after coronary artery bypass surgery.

BACKGROUND: The European system for cardiac operative risk evaluation score (EuroSCORE) has been shown to be of value in identifying patients at high risk for adverse immediate postoperative outcome after adult cardiac surgery. The aim of the present study was to evaluate EuroSCORE in predicting the 12-year outcome of patients who underwent on-pump coronary artery bypass surgery (CABG). METHODS: We calculated the EuroSCORE in 917 patients who underwent CABG. The median follow-up was 11.7 years. RESULTS: Both additive and logistic EuroSCORE had an area under the receiver operating characteristic curve of 0.856 for prediction of 30-day postoperative death. Among 912 operative survivors, the 10-year survival rates according to quintiles of additive EuroSCORE were 87.9%, 83.9%, 85.2%, 76.0%, and 51.3% (p < 0.0001). The 10-year survival rates according to quintiles of logistic EuroSCORE were 87.9%, 85.4%, 86.5%, 76.9%, and 58.9% (p < 0.0001). CONCLUSIONS: EuroSCORE is a relevant predictor of immediate and late outcome after on-pump CABG.

Preoperative C-reactive protein is predictive of long-term outcome after coronary artery bypass surgery.

BACKGROUND: Increased levels of C-reactive protein (CRP) are associated with the presence and severity of atherosclerosis, and with increased risk of coronary events as well as of cardiac events after coronary percutaneous intervention. METHODS: We have investigated whether preoperative CRP had an impact on the long-term outcome of 843 patients who underwent on-pump coronary artery bypass surgery (CABG). RESULTS: Among operative survivors, patients with preoperative CRP < 1.0 mg/dL had significantly better 12-year overall survival rate (74.1% vs 63.0%, p = 0.004) and survival freedom from fatal cardiac event (86.7% vs 78.1%). Multivariate analysis including patients' age, extracardiac arteriopathy, urgent/emergent operation, recent myocardial infarction, congestive heart failure, left ventricular ejection fraction, atrial fibrillation, transient ischemic attack/stroke, number of distal anastomoses, diabetes, and preoperative CRP > or = 1.0 mg/dL or <1.0 mg/dL, showed that the latter was an independent predictor of late all-cause mortality (p = 0.017, RR 1.60, 95% CI 1.09-2.35). Its impact on overall survival was particularly evident in patients with left ventricular ejection fraction <50% (CRP < 1.0 mg/dL: 58.7% vs CRP > or = 1.0 mg/dL: 43.7%, p < 0.00001). CONCLUSIONS: Increased preoperative levels of CRP are associated with significantly decreased overall survival after primary on-pump CABG.

Pulmonary artery blood temperature at admission to the intensive care unit is predictive of outcome after on-pump coronary artery bypass surgery.

OBJECTIVE: To evaluate whether pulmonary artery blood (PA) temperature on admission to the intensive care unit (ICU) is predictive of postoperative outcome after isolated on-pump coronary artery bypass grafting (CABG). DESIGN: A retrospective study on 1639 patients who underwent isolated on-pump CABG in whom PA temperature at admission to the ICU was available for review. RESULTS: Thirty-three patients (2.0%) died during the in-hospital stay and 87 patients (5.3%) developed low cardiac output syndrome. PA temperature at admission to the ICU was significantly associated with an increased risk of overall postoperative death (p = 0.002), cardiac death (p = 0.03), and low cardiac output syndrome (p < 0.0001), and was significantly correlated with prolonged length of ICU stay (p < 0.0001) and postoperative bleeding (p = 0.001). Patients with high PA temperature had significantly more severe comorbidities, and longer aortic cross-clamping and cardiopulmonary bypass time. The receiver operating characteristic curve showed that PA temperature at admission to the ICU in predicting postoperative death had an area under the curve of 0.660 (p = 0.002) and its best cut-off value was 36.4 degrees C (sensitivity: 63.6%, specificity: 65.2%). When the PA temperature at admission to the ICU was > or = 36.4 degrees C, the postoperative mortality and low cardiac output syndrome rates were 3.6 and 8.3%, whereas they were 1.1 and 3.7% when the PA temperature at admission to the ICU was < 36.4 degrees C (p = 0.001, p < 0.0001), respectively. CONCLUSION: Patients having a PA temperature > or =36.4 degrees C at admission to the ICU after CABG seem to be at higher risk of poor postoperative outcome.

Predictors of development of anastomotic femoral pseudoaneurysms after aortobifemoral reconstruction for abdominal aortic aneurysm.

BACKGROUND: The pathogenesis of anastomotic femoral pseudoaneurysms (AFPs) is still unclear. We have performed this long-term retrospective study of patients who underwent aortobifemoral reconstruction for abdominal aortic aneurysm (AAA) in order to better establish the long-term rate of AFP and to identify the predictors of its late occurrence. METHODS: The long-term outcome of 178 patients who underwent and survived aortobifemoral reconstruction for infrarenal AAA was reviewed. RESULTS: During a median follow-up of 5.2 years, 28 AFPs developed in 19 patients. Six AFPs were recurrent. The mean linearized rate of AFPs was 1.88% per year. At 15 years, the survival-freedom rate from AFPs was 60%, and from repair of AFPs it was 62%. The survival-freedom rate from AFP was significantly poorer in patients with chronic obstructive pulmonary disease (P = 0.017; at 10 years: 64.3% versus 92.3%), hyperlipidemia (P = 0.0056; at 10 years: 59.2% versus 87.5%), current smoking (P <0.0001; at 10 years: 65.8% versus 94.5%), and postoperative inguinal wound infection (P <0.0001; at 10 years: 42.8% versus 86.8%). Multivariate analysis showed that chronic obstructive pulmonary disease (relative risk [RR]: 3.05, 95% confidence interval [CI]: 1.04 to 8.95), current smoking (RR: 5.38, 95% CI: 1.62 to 17.90), and postoperative inguinal wound infection (RR: 9.04, 95% CI: 2.76 to 29.96) were significantly associated with the development of AFPs. The linearized rate of AFPs was significantly higher only among current smokers (P <0.0001, 4.4% versus 0.8% per year) and among those who had inguinal wound infection (P = 0.001, 9.2% versus 1.5% per year). CONCLUSIONS: Current smoking and inguinal wound infection may contribute to the development of AFP after aortobifemoral reconstruction for AAA, likely by affecting reparative connective tissue mechanisms at the anastomotic site.

Preoperative C-reactive protein and outcome after coronary artery bypass surgery.

BACKGROUND: C-reactive protein (CRP) is a predictor of early and late outcome after coronary angioplasty, but there is scant data on its impact on the outcome after coronary artery bypass grafting (CABG). METHODS: The predictive value of preoperative CRP was evaluated in a series of 764 patients who underwent on-pump CABG. RESULTS: During the in-hospital stay, 13 patients (1.7%) died, 45 (4.5%) developed low cardiac output syndrome, and 28 (3.7%) suffered minor or major cerebrovascular complications. Patients with a preoperative serum concentration of CRP>/=1.0 mg/dL had a higher risk of overall postoperative death (5.3% vs 1.1%, p = 0.001), cardiac death (4.4% vs 0.8%, p = 0.002), low cardiac output syndrome (8.8% vs 3.7%, p = 0.01), and any cerebrovascular complication (4.4% vs 3.5%, p = 0.66). Preoperative serum concentration of CRP>/=1.0 mg/dL was significantly more frequent among patients with history of myocardial infarction, diabetes, lower limb ischemia, low left ventricular ejection fraction, NYHA class IV, and in those undergoing urgent or emergency operation. At multivariate analysis, preoperative serum concentration of CRP >/= 1.0 mg/dL (p = 0.01, O.R.: 6.97) and left ventricular ejection fraction (p = 0.01, O.R.: 0.95) were independent predictors of postoperative death. Postoperative mortality rate was 0.3% among patients with preoperative CRP < 1.0 mg/dL and an ejection fraction >/=50%, whereas it was 21.4% among those with a preoperative CRP >/= 1.0 mg/dL and an ejection fraction less than 50% (p < 0.0001). CONCLUSIONS: Preoperative serum concentration of CRP in patients undergoing on-pump coronary artery bypass surgery is an important determinant of postoperative outcome.

Does angiographic severity of coronary artery disease predict postoperative outcome after coronary artery bypass surgery?

OBJECTIVE: It is not clear whether the severity of coronary artery disease as assessed on angiography has an impact on the postoperative outcome after coronary artery bypass surgery (CABG). DESIGN: The angiographic status of 15 coronary arteries/segments of 2,233 patients who underwent isolated on-pump CABG was graded according to the following criteria: 1 = no stenosis; 2 = stenosis <50%; 3 = stenosis of 50-69%; 4 = stenosis of 70-89%; 5 = stenosis of 90-99%; 6 = vessel occlusion; and 7 = vessel is not visualized. RESULTS: Thirty-seven patients (1.7%) died during the in-hospital stay and 108 (4.8%) developed postoperatively low cardiac output syndrome. Multivariate analysis showed that along with other risk factors the overall coronary angiographic score was predictive of postoperative death (p = 0.03; OR: 1.027, 95% CI: 1.003-1.052) and of low cardiac output syndrome (p = 0.04; OR: 1.172, 95% CI: 1.010-1.218). The status of the proximal segment of the left circumflex coronary artery, the diagonal arteries and the left obtuse marginal arteries was most closely associated with adverse postoperative outcome. CONCLUSION: The angiographic status of coronary arteries has an impact on the immediate outcome after CABG.

A retrospective comparative study of aortic valve replacement with St. Jude medical and medtronic-hall prostheses: a 20-year follow-up study.

OBJECTIVE: To compare the long-term clinical outcome of patients who underwent aortic valve replacement with St. Jude Medical and Medtronic-Hall mechanical prostheses. DESIGN: From June 1978 to June 1982, 43 Medtronic-Hall and 48 St. Jude Medical mechanical valves were implanted in 90 consecutive patients with aortic valve disease, and their clinical outcome was retrospectively assessed. RESULTS: At 20 years in the St. Jude Medical group and in the Medtronic-Hall group the actuarial rates of overall survival were 50 and 49% (p = NS), of cardiovascular survival 66 and 63% (p = NS), of valve-related survival 95 and 91% (p = NS), of freedom from major valve-related complications 83 and 45% (p = 0.005), from major cerebrovascular events 93 and 71% (p =0.06), from valve thrombosis 97 and 89% (p = NS), from aortic valve reoperation 93 and 88% (p = NS), from major bleeding 96 and 82% (p = 0.04), and from endocarditis 93 and 82% (p = NS), respectively. The linearized rate of overall major aortic valve prosthesis-related complications was 3.47%/year in the Medtronic-Hall valve group and 1.53%/year in the St. Jude Medical valve group (p = 0.003). Multivariate analysis showed that the type of prosthesis was predictive of freedom from valve-related complications (p = 0.01; 2.849; C.I. 95%: 1.246-6.516). CONCLUSION: The aortic St. Jude Medical mechanical valve seems to be associated with a slightly lower rate of long-term valve-related morbidity than the aortic Medtronic-Hall mechanical valve. Because of the small patient population and the retrospective nature of the study, the choice between these two prostheses should not be made only on the basis of these findings. However, these results suggest a reappraisal for further comparative studies with such an extended follow-up.