The outcome of cardiac surgery in high-risk quaternary referral patients

Cardiac transplantation is limited by donor availability and carries a considerable perioperative mortality in addition to continuing morbidity and mortality post-transplant. Some patients referred for transplantation may benefit from non-transplant cardiac surgery. This study assessed the results of non-transplant cardiac surgery in this high-risk group of patients over the 5-year period 1996-2001. Twenty-five such patients underwent conventional cardiac surgery and these were highly symptomatic, with angina and dyspnoea. All had impaired left ventricular function, 20 having left ventricular ejection fraction (LVEF)<30% and five an LVEF of 30-50%. Twelve of these patients had undergone previous cardiac surgery, nine patients required LV aneurysm surgery in addition to revascularization, and three had valve replacement plus coronary artery bypass grafting. There was one death (4% mortality). Mortality predicted by Parsonnet was 11.3% and by EuroSCORE 5.56%. Compared with all cardiac surgery patients, these high-risk patients had a prolonged intensive therapy unit stay (median 1 day, P=0.013) and hospital stay (median 12 vs. 8 days, P<0.001). Although patients referred for cardiac transplantation constitute a high-risk group for conventional cardiac surgery, the operative mortality compares favourably with that of cardiac transplantation.