| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2000;70:84-90
© 2000 The Society of Thoracic Surgeons
a Division of Cardiovascular Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
Address reprint requests to Dr Fremes, Division of Cardiovascular Surgery, Sunnybrook and Women’s College Health Sciences Center, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
e-mail: stephen.fremes{at}swchsc.on.ca
Background. The demographics of patients undergoing coronary artery bypass grafting (CABG) have changed over time and may contribute to differing operative mortality and the combination of mortality and morbidity (M + M). In this study, the trends in results are analyzed and causes are suggested.
Methods. Prospectively collected data concerning 4,839 CABG operations was divided into three time cohorts (1990 to 1992, 1993 to 1995, 1996 to 1998) and analyzed by univariate and multivariate techniques.
Results. Mean age and female gender frequency increased in the later time cohorts (60.7 ± 9.0 to 63.4 ± 9.9 years and 16.5% to 21.4%, respectively). The following comorbidities were more prevalent in the later time cohorts: diabetes (26.7% versus 18.6%), renal failure (8.5% versus 2.2%), peripheral vascular disease (20.7% versus 11.0%), previous cerebrovascular accident (6.7% versus 5.0%), urgent procedures (41.5% versus 26.9%), unstable angina (47.8% versus 31.7%), urgent CABG following myocardial infarction (17.1% versus 7.3%), previous percutaneous transluminal coronary angioplasty (8.0% versus 4.5%), ejection fraction less than 35% (20.5% versus 10.4%), (all p < 0.05). Procedurally, increased utilization of the left internal mammary artery, multiple arterial conduits, and warm blood cardioplegia occurred in the later cohorts (91.2%, 22.2%, and 80.4% versus 78.7%, 3.4%, and 38.0%, respectively). The mortality rate was 2.0% and the M + M rate was 15.6% in all 4,839 patients.
The mortality and M + M for the three cohorts were 1.6%, 2.0%, and 2.3% and 18.4%, 17.2% and 12.5%, respectively. The risk-adjusted mortality and M + M decreased from 2.4% and 15.9%, respectively, in 1990 to 1992 to 1.8% and 8.4% in 1996 to 1998 (p < 0.001). The difference in adjusted event rates was minimized when the surgical factors were entered into the model.
Conclusions. Over time, there has been a trend toward operating on older patients with more comorbidities. Though hospital mortality has been stable, risk-adjusted M + M has been in a constant decline. This decline was associated with an increased use of left internal mammary artery grafts, multiple arterial conduits, and warm blood cardioplegia during the later years of the study.
This article has been cited by other articles:
|
|
 |
|
  A. Granfeldt, D. J. Lefer, and J. Vinten-Johansen Protective ischaemia in patients: preconditioning and postconditioning Cardiovasc Res, July 15, 2009; 83(2): 234 - 246. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.-H. Yap, L. Sposato, E. Akowuah, S. Theodore, D. T. Dinh, G. C. Shardey, P. D. Skillington, J. Tatoulis, M. Yii, J. A. Smith, et al. Contemporary results show repeat coronary artery bypass grafting remains a risk factor for operative mortality. Ann. Thorac. Surg., May 1, 2009; 87(5): 1386 - 1391. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P G CAMPBELL, K S L TEO, S G WORTHLEY, M T KEARNEY, A TARIQUE, A NATARAJAN, and A G ZAMAN Non-invasive assessment of saphenous vein graft patency in asymptomatic patients Br. J. Radiol., April 1, 2009; 82(976): 291 - 295. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Massoudy, S. Wagner, M. Thielmann, U. Herold, E. Kottenberg-Assenmacher, G. Marggraf, A. Kribben, T. Philipp, H. Jakob, and S. Herget-Rosenthal Coronary artery bypass surgery and acute kidney injury--impact of the off-pump technique Nephrol. Dial. Transplant., September 1, 2008; 23(9): 2853 - 2860. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Acampa, M. Petretta, L. Evangelista, G. Nappi, L. Luongo, M. P. Petretta, and A. Cuocolo Stress cardiac single-photon emission computed tomographic imaging late after coronary artery bypass surgery for risk stratification and estimation of time to cardiac events J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 46 - 51. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Jonsson, N. Hammar, T. Nordquist, and T. Ivert Left main coronary artery stenosis no longer a risk factor for early and late death after coronary artery bypass surgery - an experience covering three decades. Eur. J. Cardiothorac. Surg., August 1, 2006; 30(2): 311 - 317. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Epstein Do Cardiac Surgery Report Cards Reduce Mortality? Assessing the Evidence Med Care Res Rev, August 1, 2006; 63(4): 403 - 426. [Abstract] [PDF]
|
|
|
|
 |
|
 L. Noyez, A. L.P. Markou, and F. C.F. van Breugel Quality of life one year after myocardial revascularization. Is preoperative quality of life important? Interactive CardioVascular and Thoracic Surgery, April 1, 2006; 5(2): 115 - 120. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. K. Toumpoulis, C. E. Anagnostopoulos, S. Balaram, D. G. Swistel, R. C. Ashton Jr, and J. J. DeRose Jr Does Bilateral Internal Thoracic Artery Grafting Increase Long-Term Survival of Diabetic Patients? Ann. Thorac. Surg., February 1, 2006; 81(2): 599 - 607. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Fuster, J. A. M. Argudo, O. G. Albarova, F. H. Sos, S. C. Lopez, M. B. Codoner, J. A. B. Minano, and I. R. Albarran Prognostic value of chronic obstructive pulmonary disease in coronary artery bypass grafting Eur. J. Cardiothorac. Surg., February 1, 2006; 29(2): 202 - 209. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. H. Lauruschkat, B. Arnrich, A. A. Albert, J. A. Walter, B. Amann, U. P. Rosendahl, T. Alexander, and J. Ennker Prevalence and Risks of Undiagnosed Diabetes Mellitus in Patients Undergoing Coronary Artery Bypass Grafting Circulation, October 18, 2005; 112(16): 2397 - 2402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Calafiore, M. Di Mauro, G. Di Giammarco, G. Teodori, A. L. Iaco, V. Mazzei, G. Vitolla, and M. Contini Single Versus Bilateral Internal Mammary Artery for Isolated First Myocardial Revascularization in Multivessel Disease: Long-Term Clinical Results in Medically Treated Diabetic Patients Ann. Thorac. Surg., September 1, 2005; 80(3): 888 - 895. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. A. Burns, M. W. A. Chu, R. J. Novick, S. A. Fox, K. Gallo, C. M. Martin, L. W. Stitt, A. P. Heidenheim, M. L. Myers, and L. Moist Perioperative N-acetylcysteine to Prevent Renal Dysfunction in High-Risk Patients Undergoing CABG Surgery: A Randomized Controlled Trial JAMA, July 20, 2005; 294(3): 342 - 350. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M.D. van den Brule, L. Noyez, and F. W.A. Verheugt Risk of coronary surgery for hospital and early morbidity and mortality after initially successful percutaneous intervention Interactive CardioVascular and Thoracic Surgery, April 1, 2005; 4(2): 96 - 100. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Jarvinen, J. Julkunen, T. Saarinen, J. Laurikka, and M. R. Tarkka Effect of Diabetes on Outcome and Changes in Quality of Life After Coronary Artery Bypass Grafting Ann. Thorac. Surg., March 1, 2005; 79(3): 819 - 824. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Mallik, H. M. Krumholz, Z. Q. Lin, S. V. Kasl, J. A. Mattera, S. A. Roumains, and V. Vaccarino Patients With Depressive Symptoms Have Lower Health Status Benefits After Coronary Artery Bypass Surgery Circulation, January 25, 2005; 111(3): 271 - 277. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Di Mauro, A. L. Iaco, M. Contini, G. Teodori, G. Vitolla, M. Pano, G. Di Giammarco, and A. M. Calafiore Reoperative Coronary Artery Bypass Grafting: Analysis of Early and Late Outcomes Ann. Thorac. Surg., January 1, 2005; 79(1): 81 - 87. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Lev-Ran, R. Mohr, D. Pevni, N. Nesher, Y. Weissman, D. Loberman, and G. Uretzky Bilateral internal thoracic artery grafting in diabetic patients: Short-term and long-term results of a 515-patient series J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1145 - 1150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Gaudino, F. Glieca, F. Alessandrini, G. Nasso, C. Pragliola, N. Luciani, M. Morelli, and G. Possati High risk coronary artery bypass patient: incidence, surgical strategies, and results Ann. Thorac. Surg., February 1, 2004; 77(2): 574 - 579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Sanisoglu, M. Guden, Z. Bayramoglu, E. Sagbas, C. Dibekoglu, S. Y. Sanisoglu, and B. Akpinar Does off-pump CABG reduce gastrointestinal complications? Ann. Thorac. Surg., February 1, 2004; 77(2): 619 - 625. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Noyez and F. M. van Eck Long-term cardiac survival after reoperative coronary artery bypass grafting Eur. J. Cardiothorac. Surg., January 1, 2004; 25(1): 59 - 64. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Davierwala, M. Maganti, and T. M. Yau Decreasing significance of left ventricular dysfunction and reoperative surgery in predicting coronary artery bypass grafting-associated mortality: A twelve-year study J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1335 - 1344. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Mallidi, J. Sever, M. Tamariz, S. Singh, N. Hanayama, G. T. Christakis, G. Bhatnagar, C. A. Cutrara, B. S. Goldman, and S. E. Fremes The short-term and long-term effects of warm or tepid cardioplegia J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 711 - 720. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Pinna Pintor, S. Colangelo, and M. Bobbio Evolution of case-mix in heart surgery: from mortality risk to complication risk Eur. J. Cardiothorac. Surg., December 1, 2002; 22(6): 927 - 933. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. Szabo, E. Hakanson, and R. Svedjeholm Early postoperative outcome and medium-term survival in 540 diabetic and 2239 nondiabetic patients undergoing coronary artery bypass grafting Ann. Thorac. Surg., September 1, 2002; 74(3): 712 - 719. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. S. M. Tsang, M. Enriquez-Sarano, W. K. Freeman, M. E. Barnes, L. J. Sinak, B. J. Gersh, K. R. Bailey, and J. B. Seward Consecutive 1127 Therapeutic Echocardiographically Guided Pericardiocenteses: Clinical Profile, Practice Patterns, and Outcomes Spanning 21 Years Mayo Clin. Proc., May 1, 2002; 77(5): 429 - 436. [Abstract] [PDF]
|
|
|
|
|
|
N. Sadeghi, S. Sadeghi, Z. A. Mood, and A. Karimi Determinants of operative mortality following primary coronary artery bypass surgery Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 187 - 192. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. M. van Eck, L. Noyez, F. W.A. Verheugt, and R. M.H.J. Brouwer Changing profile of patients undergoing redo-coronary artery surgery Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 205 - 211. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Novick, S. A. Fox, L. W. Stitt, B. B. Kiaii, S. A. Swinamer, R. Rayman, T. R. Wenske, and W. D. Boyd Assessing the learning curve in off-pump coronary artery surgery via CUSUM failure analysis Ann. Thorac. Surg., January 1, 2002; 73(1): S358 - 362. [Full Text] [PDF]
|
|
|
|
|
|
I. Iglesias, F.E. Ralley, J.M. Murkin, and R. Novick Development of a predictive index for complications in cardiac surgery: preliminary report on retrospective observations Ann. Thorac. Surg., January 1, 2002; 73(1): S372 - 372. [Full Text] [PDF]
|
|
|
|
|
|
P. Menasche The systemic factor: the comparative roles of cardiopulmonary bypass and off-pump surgery in the genesis of patient injury during and following cardiac surgery Ann. Thorac. Surg., December 1, 2001; 72(6): S2260 - 2265. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
