The impact of cardiopulmonary bypass time on the Sequential Organ Failure Assessment score after cardiac surgery.

OBJECTIVES: Postoperative organ dysfunction is common after cardiac surgery, particularly when cardiopulmonary bypass (CPB) is used. The Sequential Organ Failure Assessment (SOFA) score is validated to predict morbidity and mortality in cardiac surgery. However, the impact of CPB duration on postoperative SOFA remains unclear. METHODS: This is a retrospective study. Categorical values are presented as percentages. The comparison of SOFA groups utilized the Kruskal-Wallis chi-squared test, complemented by ad hoc Dunn's test with Bonferroni correction. Multinomial logistics regressions were employed to evaluate the relationship between CPB time and SOFA. RESULTS: A total of 1032 patients were included. CPB time was independently associated with higher postoperative SOFA scores at 24 h. CPB time was significantly higher in patients with SOFA 4-5 (**P = 0.0022) or higher (***P < 0.001) when compared to SOFA 0-1. The percentage of patients with no/mild dysfunction decreased with longer periods of CPB, down to 0% for CPB time >180min (50% of the patients with >180m in of CPB presented SOFA ≥ 10). The same trend is observed for each of the SOFA variables, with higher impact in the cardiovascular and renal systems. Severe dysfunction occurs especially >200 min of CPB (cardiovascular system >100 min; other systems mainly >200 min). CONCLUSIONS: CPB time may predict the probability of postoperative SOFA categories. Patients with extended CPB durations exhibited higher SOFA scores (overall and for each variable) at 24 h, with higher proportion of moderate and severe dysfunction with increasing times of CPB.

Sequential Organ Failure Assessment Score in the ICU As a Predictor of Long-Term Survival After Cardiac Surgery.

OBJECTIVES: The Sequential Organ Failure Assessment (SOFA) score is a predictor of mortality in ICU patients. Although it is widely used and has been validated as a reliable and independent predictor of mortality and morbidity in cardiac ICU, few studies correlate early postoperative SOFA with long-term survival. DESIGN: Retrospective observational cohort study. SETTING: Tertiary academic cardiac surgery ICU. PATIENTS: One-thousand three-hundred seventy-nine patients submitted to cardiac surgery. INTERVENTIONS: SOFA 24 hours, SOFA 48 hours, mean, and highest SOFA scores were correlated with survival at 12 and 24 months. Wilcoxon tests were used to analyze differences in variables. Multivariate logistic regressions and likelihood ratio test were used to access the predictive modeling. Receiver operating characteristic curves were used to assess accuracy of the variables in separating survivor from nonsurvivors. MEASUREMENTS AND MAIN RESULTS: Lower SOFA scores have better survival rates at 12 and 24 months. Highest SOFA and SOFA at 48 hours showed to be better predictors of outcome and to have higher accuracy in distinguishing survivors from nonsurvivors than initial SOFA and mean SOFA. A decreasing score during the first 48 hours had mortality rates of 4.9%, while an unchanged or increased score was associated with a mortality rate of 5.7%. CONCLUSIONS: SOFA score in the ICU after cardiac surgery correlated with survival at 12 and 24 months. Patients with lower SOFA scores had higher survival rates. Differences in survival at 12 months were better correlated with the absolute value at 48 hours than with its variation. SOFA score may be useful to predict long-term outcomes and to stratify patients with higher probability of mortality.

[Advantages of off-pump coronary bypass surgery over conventional coronary bypass surgery]. / Vantagens da cirurgia coronária sem CEC sobre a cirurgia coronária convencional.

UNLABELLED: Comparison between off-pump coronary bypass surgery ( OP-CABG )and conventional CABG ( C-CABG ) remains a controversial issue. OBJECTIVE: To compare short and long term OP-CABG and C-CABG results in high-risk patients ( pts ), in absence of usual bias. MATERIAL AND METHODS: A prospective observational study of 752 pts ( 252 pts with C-CABG and 500 with OP-CABG ) consecutively operated throughout 23 months by 4 surgeons largely experienced in both CABG modalities. For comparison of results, two groups ( Gr ) of pts were constituted - GrA, with 252 C-CABG pts, and GrB, with 252 OP-CABG pts - being the pts blindly matched for gender ( female sex - 51 pts ), age ( mean of 65 vs 64 yrs ), angiographic data ( 3 - VD ÷ left main - 92 % vs 90 % ), additive Euroscore ( mean of 4.6 vs 4.6 ), prior myocardial infarction ( 58 % vs 59 % ), history of diabetes ( 48 % vs 49 % ) or hypertension ( 83 % vs 83 % ). Other clinical data ( GrA vs GrB ): left ventricular dysfunction - 39 % vs 34 % ( NS ); logistic Euroscore - mean of 5.4 % vs 5.9 % ( NS ). Surgical results, in-hospital clinical evolution, in-hospital costs ( intra-operative and major post-operative costs ), and short-term ( mean of 50 days ) and long-term ( mean of 5 years ) follow-up were object of evaluation. Results ( GrA vs GrB ): 1 ) Nr of bypasses ÷ pt 2.9 vs 2.4 ( p < 0.01 ); nr of arterial conduits ÷ pt 1.2 vs 1.2; complete revascularization 60 % vs 60 %; surgical total time 155 ± 49 vs 136 ± 42 min ( p < 0.001 ); surgical total time in pts with 3 bypasses 157 ± 41 vs 156 ± 37 min ( NS ). 2 ) In-hospital post-operative evolution: inotropic support ( IS ) 46 % vs 29 % ( p < 0.001 ); heavy IS 14 % vs 6 % ( p < 0.025 ) ; uncomplicated post-operative course 18 % vs 26 % ( p < 0.025 ); significant CV events ( excluding atrial tachyarrhythmias ) 33 % vs 20 % ( p < 0.01 ); infection 22 % vs 14 % ( p < 0.05 ); severe complications 22 % vs 9.5 % ( p < 0.001 ); mean intensive care length of stay 4 vs 3 days ( p < 0.01 ); surgery-to-discharge length of stay 11.3 vs 9.8 days ( p ⋝ 0.05 ); in-hospital mortality ( HM ) 4.4 % vs 2.0 % ( NS ); HM + disabling chronic morbidity 7.5 % vs 3.2 % ( p < 0.05 ) . 3 ) In-hospital costs: intra-operative - superposable; post-operative - excess of about 900 euro ÷ pt in GrA. 4 ) Short-term follow-up: asymptomatic pts - 75 % vs 85 % ( p < 0.025 ); post-discharge complications - 8.3 % vs 7.7 % ( NS ); probability of being alive and asymptomatic + 17 % in GrB ( p < 0.01 ); mortality 0 % vs 0 %. 5 ) Long-term-follow-up ( 87 % vs 90 % pts ), at 5 years: pts alive with no clinical evidence of active coronary artery disease 72 % vs 75 % ( NS ); significant ÷ severe cardiac events of coronary origin 18.8 % vs 9.3 % ( p < 0.025 ); elective PTCA 4.8 % vs 2.3 % ( NS ); all-cause mortality 11.8 % vs 11.9 %; coronary mortality 6.9 % vs 4.4 % ( NS ). CONCLUSIONS: In experienced hands and before high-risk pts, OP-CABG offers lesser post-operative risks than C-CABG, with clear and positive consequences on in-hospital costs and short-term follow-up. During long-term follow-up, the revascularization benefits obtained by OP-CABG are not inferior to those conferred by C-CABG, and a significant reduction of the incidence of severe cardiac events can even be seen in a particular subset of pts.