Predictive factors of mortality in acute aortic dissection and validity of the euroscore algorithm in a small-sized cardiac surgery institution

Abstract Introduction: Acute aortic dissection (AAD) is a devastating surgical emergency, with high operative mortality. Several scoring algorithms have been used to establish the expected mortality in these patients. Our objective was to define the predictive factors for mortality in our center and to validate the EuroSCORE and Penn classification system. Methods: Patients who underwent surgery for AAD from 2006 to 2016 were retrieved from the institution's database. Preoperative, operative and postoperative variables were collected. Observed and expected mortality was calculated by EuroSCORE. Logistic regression analysis and Cox regression analysis were performed to find predictors of operative mortality and survival, respectively. The receiver operating characteristic (ROC) curves were plotted for logistic EuroSCORE, and the area under the ROC curve (AUC) was calculated. Results: 87 patients (27.6% female) underwent surgery for AAD. The mean age was 58.6±9.7 years. Expected and observed operative mortality was 25.8±15.1% and 20.7%, respectively. Penn Aa, Ab and Abc shared similar observed/expected (O/E) mortality ratio. The only independent predictor of operative mortality (OR: 3.63; 95% CI: 1.19-11.09) and survival (HR: 2.6; 95% CI: 1.5-4.8) was female gender. EuroSCORE showed a very poor prediction capacity, with an AUC=0.566. Conclusion: Female gender was the only independent predictor of operative mortality and survival in our institution. EuroSCORE is a poor scoring algorithm to predict mortality in AAD, but with consistent results for Penn Aa, Ab and Abc.

The beneficial effect of anticoagulation in aortic bioprosthesis is associated with its size

Abstract Objective: To evaluate the clinical and echocardiographic outcomes in aortic valve replacement (AVR) patients with aortic bioprosthesis under oral anticoagulation (OA). Methods: Patients who underwent AVR with bioprosthesiswere prospectively enrolled. They were classified based on postoperative use of OA. Clinical and operative variables were collected. Echocardiographic and clinical follow-ups were performed two years after surgery. The primary outcome evaluated was change in transprosthetic gradient. Secondary outcomes analyzed were change in New York Heart Association (NYHA) class, major bleeding episodes, hospitalization, stroke, and transient ischemic attack. Results: We included 103 patients (61 without OA and 42 with OA). Clinical characteristics were similar among groups, except for younger age (76±6.3 vs. 72.4±8.1 years, P=0.016) and higher prevalence of atrial fibrillation (0% vs. 23.8%, P<0.001) in the OA group. Mean (21.4±10 mmHg vs. 16.8±7.7 mmHg, P=0.037) and maximum (33.4±13.7 mmHg vs. 28.4±10.2 mmHg, P=0.05) transprosthetic gradients were higher in patients without OA. Improvement in NYHA class was more frequent in patients with OA (73% vs. 45.3%, P=0.032). Major bleeding, stroke, and hospitalization were similar among groups. OA was the only independent predictor for improvement of NYHA class after multivariate logistic regression analysis (odds ratio [OR]: 5.9, 95% confidence interval [CI]: 1.2-29.4; P=0.028). Stratification by prosthesis size showed that patients with ≤ 21 mm prosthesis benefited from OA. Conclusion: Early anticoagulation after AVR with bioprosthesis was associated with significant decrease of transprosthesis gradient and improvement in NYHA class. These associations were seen mainly in patients with ≤ 21 mm prosthesis.

CANG and preoperative use of beta-blockers in patients with stable angina are associated with better cardiovascular survival

Abstract Objective: In contrast to unstable angina, optimal therapy in patients with stable angina is debated. Our aim was to evaluate the outcomes of patients with stable angina scheduled for isolated coronary artery bypass grafts and the effect of preoperative use of beta-blockers. Overall and cardiovascular survivals were our primary outcome. Operative mortality and postoperative complications along with subgroup analysis of diabetic patients were our secondary outcomes. Methods: Retrospective evaluation of patients with stable angina scheduled for isolated coronary artery bypass grafts was included. Pre- and postoperative variables were extracted from the institution database. Survival was obtained from the National Registry. Results: We included 282 patients with stable angina, with a mean age of 65.6±9.5 years. 26.6% were female and 38.7% had diabetes. Three-vessel disease was present in 76.6% of patients. Previous beta-blocker treatment was evident in 69.9% of patients. 10-year overall survival in the whole population was 60.5% (95% confidence interval [CI]: 50.3-70.7%). Operative mortality during the study period was 3.5%. Patients with preoperative use of beta-blocker therapy had better overall survival (9.0 years, 95%CI: 8.6-9.5) than those without treatment (7.9 years, 95%CI: 7.1-8.8 years; P=0.048). Predictors for overall survival were: hypertension, diabetes, and age. Predictors for cardiovascular survival in diabetic patients were: beta-blocker use, gender, and age. Conclusion: Coronary artery bypass grafts surgery in patients with stable angina carries low operative mortality, postoperative complications, and excellent long-term cardiovascular survival. The preoperative use of beta-blockers in diabetic patients is associated with better cardiovascular survival after coronary artery bypass grafts.

Mortalidad y características clínico-epidemiológicas en el Servicio de Emergencia del INSN en el periodo del 2001 al 2010 / Mortality and clinical - epidemiological characteristics in the Emergency service of the INSN in the period from 2001 to 2010

Introducción.- La mortalidad infantil es uno de los más importantes marcadores en desarrollo de salud y de calidad de vida de una población, con respecto al área de emergencia esta refleja la atención inmediata y efectiva en el tratamiento de un paciente pediátrico. Objetivos.- Conocer la mortalidad y características clinicas-epidemiologicas en el servicio de emergencia en el Instituto Nacional de Salud del Niño durante el periodo 2001 - 2010. Material y Métodos.- Estudio retrospectivos. Se incluyo 454 historias clínicas de pacientes entre 0-18 años de edad fallecidos en el servicio de emergencias del INSN durante el periodo 2001-2010. Se utilizo un formulario de recolección de datos para obtener la información necesaria. Resultados.- Un 38 por ciento de pacientes fallecieron por neumonía que fue seguida de un 20 por ciento de MEC y otras infecciones. En lo que corresponde a comorbilidades se obtuvo un 19 por ciento tanto en paciente fallecidos sin comorbilidades como en pacientes fallecidos con cardiopatías congénitas. Conclusiones.- Se encontró una reducción significativa de la tasa de mortalidad...

Introduction. - Infant mortality is one of the most important markers in developing health and quality of Iife of a population with respect to the emergency area that reflects the immediate attention and effective in treating a pediatric patient. Objectives. - To know the mortality and c1inical and an epidemiological characteristics in the emergency department at the National Institute of Child Health during the period 2001 to 2010. Material and Methods. - A retrospective study. It included 454 records of patients between 0 - 18 years of age died in the emergency department of INSN during the period 2001 -2010. We used a data collection form to obtain the necessary information. Results. - A 38 per cent of patients died from pneumonia which was followed by 20 per cent of MEC and other infections. As relates to comorbidities were obtained by 19 per cent in both patients died without comorbidities in patients with congenital heart disease died. Conclusions. - We found a significant reduction in mortality...