Operative risk assessment in coronary artery bypass surgery, 1990-1993: evaluation of perioperative variables.
Patient characteristics and the results of cardiac surgery change with time. To achieve the best possible treatment a continual analysis of results is necessary. The present study analyzes 1225 consecutive patients undergoing isolated aortocoronary bypass surgery for the four-year period ending September 1993. Average age was 63 years (range 32-86 years), 927 (75.7%) patients were male and 298 (24.3%) were female. Hospital mortality was 2.2% (17/787) for elective surgery, 6.3% (21/336) for urgent surgery, and 9.8% (8/82) for emergency surgery. Intraoperative variables increasing independently operative mortality as evidenced by multivariate analysis were the following: prolonged aortic cross-clamping time (p < 0.0001), absence of cold-blood cardioplegia (p = 0.0012), absence of bilateral use of internal mammary artery (p = 0.0035). Likewise, intraoperative variables influencing major adverse outcome (operative mortality and/or need for intra-aortic balloon pulsation) were the following: prolonged aortic cross-clamping time (p < 0.0001), absence of cold-blood cardioplegia (p = 0.0360). In conclusion, global ischemic time was the dominant variable in predicting operative outcome. Furthermore, a protective effect of cold blood cardioplegia and bilateral internal mammary artery grafting was evidenced.
Louagie
Y
Y
Division of Cardiovascular and Thoracic Surgery, University Clinics of Mont Godinne (Catholic University of Louvain), Mont Yvoir, Belgium.
Buche
M
M
Jamart
J
J
Eucher
P
P
Haxhe
J P
JP
Schoevaerdts
J C
JC
D000768:Anesthesia, General; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000401:mortality / Q000706:statistics & numerical data; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D007430:Intraoperative Care; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015428:Myocardial Reperfusion Injury / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome