In-hospital and long-term outcomes after open-heart surgery in turkish octogenarians: a single-center study

Abstract Objective: We aimed to analyze the early and long-term results of open-heart surgery in Turkish patients aged 80 years or older who were operated on at our center. Methods: All patients aged 80 years or older who underwent surgery between January 2000 and December 2013 at a high-level heart center were included in the study. The in-hospital data of study patients were obtained from the electronic database and from the hospital files. Survival data were analyzed as a long-term outcome. Results: A total of 245 patients aged 80-93 years were evaluated in the study. The patients were followed up 5.4±3.7 years after open-heart surgery. In-hospital mortality rates were 10% in elective cases and 15.1% overall. Age ≥85 years, chronic kidney disease, chronic obstructive pulmonary disease, and emergency surgery were independent predictors of in-hospital mortality. The median survival time was found to be 4.4±0.3 years for all participants. The long-term survival of patients who underwent emergency cardiac surgery was significantly lower than that of elective patients (log-rank <0.001). Conclusion: Octogenarians have satisfactory long-term outcomes after open-heart surgery when operated electively. On the other hand, patients operated under emergency conditions have worse in-hospital outcomes and long-term follow-up results.

Analysis of readmissions to the intensive care unit after coronary artery bypass surgery: ten years experience

Abstract Objective: To evaluate the frequency, causes, and related predictive factors of intensive care unit (ICU) readmissions after coronary artery bypass grafting (CABG) surgery. Methods: A total of 4112 consecutive patients who underwent on-pump CABG between January 2007 and January 2017 were retrospectively evaluated. The patients were divided into two groups as patients with and without ICU readmission. Demographic and perioperative characteristics were compared between the two groups. Results: The ICU readmission rate was 3.5%. The most common reasons for ICU readmissions were respiratory (29%) and cardiac (23.4%) complications. The 90-day mortality risk was significantly higher in the readmitted patients than the non-readmitted patients (22.1% and 1.6%, respectively; P<0.001; OR=17.6; 95% CI=11.19-28.41). Severe left ventricular dysfunction, chronic obstructive pulmonary disease, end-stage renal disease, emergency CABG, EuroSCORE II > 5%, cross-clamp time > 35 minutes, postoperative respiratory complications, neurological complications, and cardiac complications showed a strong association with ICU readmissions. Conclusion: ICU readmission after CABG is associated with an increased mortality rate. Evaluation, not only of patients' comorbidities, but also of intraoperative conditions and postoperative complications, is important to identify patients at risk for ICU readmission.

Prognostic value of coronary dominance in patients undergoing elective coronary artery bypass surgery

Abstract Objective: To evaluate the clinical impact of coronary dominance type in terms of early and long-term outcomes in patients undergoing elective coronary artery bypass grafting (CABG). Methods: A total of 844 consecutive patients who underwent elective CABG were divided into two groups based on preoperative angiographic views as left dominant (LD) and right dominant or co-dominant (RD+CD). The measured outcomes were postoperative complications, 30-day mortality, long-term mortality, and major adverse cardiac and cerebrovascular events (MACCE). Results: RD+CD was present in 87.9% (n=742) and LD in 12.1% (n=102) of patients. Postoperative complications, 30-day mortality, and 30-day readmissions were similar in both groups. The median duration of follow-up was 3.4 years. LD was not an independent predictor of mortality (adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI] 0.89-2.45, P=0.12), but it was an independent predictor of MACCE in the long term (adjusted HR 2.18, 95% CI 1.39-3.42, P=0.001). Conclusion: In patients undergoing elective surgical revascularization, left coronary dominance is associated with increased MACCE risk in the long term. Therefore, the assessment of coronary dominance type should be an integral part of outpatient management after CABG.

Predicting outcomes of penetrating cardiovascular injuries at a rural center by different scoring systems

Abstract Objective: To compare the anatomical and physiological scoring systems and the outcomes of surgical management of penetrating cardiovascular trauma at a rural center. Methods: Seventy-seven patients underwent emergency surgery at our center between January/2012 and October/2018 due to penetrating cardiovascular trauma. Injury Severity Score (ISS), Revised Trauma Score (RTS), New Injury Severity Score (NISS), and Trauma and Injury Severity Score (TRISS) were calculated. The validation of these risk scores to predict mortality was assessed by the area under the receiver operating characteristic curve analysis. Results: All trauma scores were correlated with mortality. As ISS, NISS, and TRISS values increased and RTS values decreased, the mortality rate increased. The area under the curve (AUC) in the receiver operating characteristic curve analysis was 0.943 for TRISS, 0.915 for RTS, 0.890 for ISS, and 0.896 for NISS (P<0.001 for each). Logistic regression analysis revealed that scores were correlated with mortality (P<0.001 for each). By investigating cardiac injuries alone, only TRISS and RTS results correlated with mortality for cardiac injuries (Mann-Whitney U test, P=0.003 and P=0.01, respectively). The AUC was only statistically significant for TRISS and RTS (AUC=0.929, P<0.05 for both). For vascular injuries, all the scores were significantly correlated with in-hospital mortality (Mann-Whitney U test, P<0.001 for each). TRISS had the highest AUC (AUC=0.946, P<0.001). Conclusion: TRISS has the highest predictivity for in-hospital mortality in patients with penetrating cardiovascular trauma.