Key result
Low LVEF and elevated creatinine remain linked to higher mortality risk after conventional cardiac surgery.
Why the study?
Do modern techniques and clinical practices in cardiac surgery reduce mortality and mitigate risk factors compared to earlier practices?
Cohort (n=1,036)
Do modern techniques and clinical practices in cardiac surgery reduce mortality and mitigate risk factors compared to earlier practices?
Modern techniques and clinical practices in the 1990s mitigated well-recognized risk factors and reduced mortality in conventional cardiac surgery.
Answers are grounded in this paper and cite their sources.
Supports mortality reduction via modern cardiac surgery practices; leaves open whether LVEF ≤30% and creatinine risks are fully mitigated.
With the increasing number of treatment options for heart disease, decision-making requires profiles of risk for conventional cardiac surgery. Refinements in techniques and clinical practices seem to have reduced surgical risk. This study was performed to determine current risk factors. From July 1, 1990, to June 30, 1996, 1,036 consecutive patients underwent 1,042 heart operations using standard incisions and cardiopulmonary bypass with cardioplegia. Univariate and multivariate analyses using a logistic regression model were performed to determine factors significant for combined 30-day and hospital mortality. To determine if there were trends in the results and the risk factors, the last 500 consecutive cases in the series were analyzed separately. Overall, 30-day mortality was 17 of 1,042 (1.6%) and combined 30-day and hospital mortality was 27 of 1,042 (2.6%). Significant risk factors for combined 30-day and hospital mortality by multivariate analyses were: emergent/resuscitative status, preoperative dialysis, left ventricular ejection fraction < or = 30%, valve operation, and creatinine > or = 1.5 mg/dl. Comparison with baseline characteristics of the patients undergoing the last 500 consecutive operations to the earlier 542 operations in the study group showed that risk factors had a very similar profile for the 2 groups. The overall 30-day mortality for the last 500 consecutive operations was 5 of 500 (1.0%) and combined 30-day and hospital mortality was 8 of 500 (1.6%). The significant risk factors by multivariate analyses were reduced to left ventricular ejection fraction < or = 30% and creatinine > or = 1.5 mg/dl. These results indicate that modern techniques and clinical practices have mitigated well-recognized risk factors in conventional cardiac surgery and this trend is ongoing.
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Katz et al. (1998) conducted a cohort in Heart disease requiring conventional cardiac surgery (n=1,036). Risk factors for cardiac surgery was evaluated on Combined 30-day and hospital mortality. In 1,036 patients undergoing conventional cardiac surgery, overall combined 30-day and hospital mortality was 2.6%, with LVEF ≤30% and creatinine ≥1.5 mg/dl remaining significant risk factors.
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