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Published on: September 15, 2023
[Comorbidity in surgical myocardial revascularization: risk factors or contraindications for surgery]
Tiziano Colombo1, Stefano Pelenghi, Giuseppe Bruschi
1U. O. di Cardiochirurgia, Dipartimento Cardio-Toraco-Vascolare "A. De Gasperis", A.O. Niguarda Ca' Granda, Milano.
Insights
Comorbidity significantly impacts preoperative risk in surgical myocardial revascularization. Despite increased patient complexity, modern techniques reduce in-hospital mortality, highlighting the need to assess long-term comorbidity effects.
Area of Science:
- Cardiovascular Surgery
- Medical Outcomes Research
Background:
- Surgical myocardial revascularization patient evolution complicates risk stratification and outcome comparison.
- Preoperative mortality risk assessment is challenging due to increasing patient comorbidities.
Purpose of the Study:
- To determine the prognostic significance of comorbidity in patients undergoing surgical myocardial revascularization.
- To analyze trends in patient characteristics and outcomes over time.
Main Methods:
- Retrospective analysis of 4999 patients undergoing surgical myocardial revascularization across four distinct time periods.
- Evaluation of preoperative morbidity, in-hospital results, and mortality rates.
Main Results:
- Observed increase in older age, female sex, comorbidity, three-vessel disease, and severe left ventricular dysfunction over time.
- Surgical mortality decreased to 2.3%.
- Renal insufficiency identified as the sole independent risk factor for in-hospital mortality in the most recent period (1999-2002).
Conclusions:
- Advancements in cardiac-surgical techniques have improved in-hospital mortality despite higher preoperative risk.
- Effective management of comorbidity during perioperative phases is crucial.
- Further investigation into the long-term impact of comorbidity, independent of surgical intervention, is essential for decision-making.
Background:
The worsening evolution of patients undergoing surgical myocardial revascularization makes it difficult the stratification of the preoperative mortality risk, a correct evaluation of results and the comparison of results of different centers. The aim of the study was to evaluate the prognostic weight of comorbidity in surgical myocardial revascularization.
Methods:
We evaluated the characteristics of preoperative morbidity in 4999 patients who underwent surgical myocardial revascularization during four different periods (1979-1980, 1991-1992, 1994-1998, 1999-2002). We also evaluated the in-hospital results.
Results:
By comparing the four different periods, an increase in older age, female sex, comorbidity, three-vessel disease, and severe left ventricular dysfunction was observed. Surgical mortality decreased to 2.3%. Multivariate analysis of the 1999-2002 period showed that only renal insufficiency was a risk factor for in-hospital mortality.
Conclusions:
Although the preoperative risk is higher, nowadays hospital mortality is reduced thanks to new cardiac-surgical techniques and approaches that increasing the capacity of controlling comorbidity in the pre-, intra- and postoperative course. For a correct decision-making process it is crucial to assess how much comorbidity may influence the long-term follow-up in these patients independently of surgical myocardial revascularization.
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