Have improvements in myocardial protection influenced a surgeon's choice of coronary artery bypass surgery?
The aim of this study is to determine whether improvements in myocardial protection strategy have influenced the surgeon's choice of coronary artery bypass surgery. Between February 2002 and April 2009, a total of 662 patients underwent coronary artery bypass surgery under the provision of a single consultant surgeon. Operative mortality was defined as in-hospital death and comparison was made based on both the observed and expected mortalities as derived from the logistic EuroSCORE. Of the 662 patients who underwent cardiac surgery, 155 had off-pump whilst 507 had conventional coronary artery bypass surgery. The observed mortalities improved over the years in line with the improvements in myocardial protection strategy despite the increasing risk as predicted by the logistic EuroSCORE, with a reduction in the ratio of observed to expected mortalities of 1.2 in the off-pump group to 0.4 in the conventional group who had better myocardial protection. This has lead to a change in practice being predominantly off-pump at the beginning to that of conventional surgery in the later part of the study. As the case mix of patients gets worse with the increasing severity of multi-vessel disease and poor ventricular function, myocardial protection becomes crucial to the surgeon's preoperative assessment.
Department of Cardiac Surgery, Ground Floor West Wing, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK. reubenj@hotmail.com
Reubendra
R
Jeganathan
Gianfranco
G
Campalani
D000368:Aged; D002755:Choice Behavior; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000401:mortality; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome