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Predictors of operative mortality following primary coronary artery bypass surgery
Harpreet Wasir1, Yatin Mehta, Mandakini Pawar
1Depatment of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, New Delhi, India.
Insights
Predicting operative mortality after coronary artery bypass graft (CABG) surgery is crucial. Key predictors include low left ventricular ejection fraction (LVEF), ventricular arrhythmias, and low cardiac output (CO), aiding in patient management.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Outcomes Research
Background:
- Current quality assessment for coronary artery bypass graft (CABG) surgery, primarily based on 30-day risk-adjusted operative mortality, is insufficient for comprehensive outcome evaluation.
- Predicting operative mortality before and after CABG is essential for improving patient care and surgical planning.
Purpose of the Study:
- To identify pre-operative and post-operative factors that predict operative mortality in patients undergoing primary isolated CABG.
- To enhance risk stratification and inform surgical and post-operative management strategies.
Main Methods:
- Prospective study of 1000 patients undergoing primary isolated CABG.
- Patients divided into non-survivor (n=12) and survivor (n=988) groups.
- Analysis using univariate and multivariate statistical models.
Main Results:
- Univariate analysis identified risk factors including recent myocardial infarction, intra-aortic balloon counterpulsation (IABC), left ventricular ejection fraction (LVEF) <25%, ventilator-associated pneumonia (VAP), tracheostomy, re-exploration, ventricular arrhythmias, low cardiac output (CO), multiple blood transfusions, post-operative renal dysfunction, and prolonged ICU/hospital stay.
- Multivariate analysis revealed that LVEF <25%, VAP, ventricular arrhythmias, and low CO independently predicted mortality.
Conclusions:
- Operative mortality after CABG can be predicted by considering factors such as LVEF, IABC use, ventricular arrhythmias, and low CO.
- Early identification of these risk factors can guide surgical planning and post-operative care to reduce morbidity and mortality.
Background:
Although quality assessment of coronary artery patients can be done by 30 days risk-adjusted operative mortality, it is still insufficient to study the outcome after primary coronary artery bypass graft surgery (CABG). In our study, we attempted to determine the factors, which can help predict operative mortality before and after CABG.
Methods:
The study population consisted of 1000 prospective patients who underwent primary isolated CABG. Assessment was done by dividing the patients into two groups, i.e. non-survivors ( n= 12) and survivors ( n= 988). Data were analyzed using both univariate and multivariate models.
Results:
On univariate analysis, recent acute myocardial infarction, intra-aortic balloon counterpulsation (IABC), left ventricular ejection fraction (LVEF) <25%, ventilator-associated pneumonia (VAP), tracheostomy, re-exploration, ventricular arrhythmias, low cardiac output (CO), multiple blood transfusions, post-operative renal dysfunction and longer intensive care unit and hospital stay were found as risk factors for mortality. Multivariate analysis showed that LVEF <25%,VAP, ventricular arrhythmias and low CO independently predicted mortality. Prior knowledge of these risk factors can help not only in predicting the outcome and the risks but also helps to plan the surgical and post-operative course of the patients to improve the morbidity and mortality.
Conclusion:
Our data suggest that operative mortality can be predicted prior to and after surgery considering factors such as LVEF, use of IABC, onset of ventricular arrhythmias and low CO.
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