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Reduced 30-day mortality in men after elective coronary artery bypass surgery with minimized extracorporeal
Michael Ried1, Reinhard Kobuch, Leopold Rupprecht
1Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg 93053, Germany. micha.ried@t-online.de
Insights
Minimally invasive extracorporeal circulation (MECC) in male coronary surgery patients was associated with significantly lower 30-day mortality. This approach also reduced hospital stay and neurocognitive dysfunction compared to conventional methods.
Area of Science:
- Cardiovascular Surgery
- Medical Technology
- Patient Outcomes
Background:
- The impact of minimized extracorporeal circulation (MECC) on coronary surgery mortality is debated.
- Gender is a significant factor influencing surgical outcomes.
Purpose of the Study:
- To investigate the association between MECC and 30-day mortality in male patients undergoing elective coronary surgery.
- To compare outcomes between MECC and conventional extracorporeal circulation (CECC).
Main Methods:
- Propensity score matching was used to analyze 1,005 male patients undergoing MECC and 1,005 undergoing CECC.
- Data were collected from elective coronary surgery procedures performed between January 2004 and May 2009.
- The primary outcome was 30-day mortality.
Main Results:
- MECC was associated with a significantly lower 30-day mortality rate (0.8% vs 2.7%).
- Patients undergoing MECC experienced shorter postoperative hospital stays and reduced incidence of neurocognitive dysfunction.
- No significant differences were observed in chest tube drainage or acute kidney injury risk between the groups.
Conclusions:
- Propensity score analysis suggests an association between MECC and reduced 30-day mortality in male patients.
- Further research is warranted to confirm these findings and explore other potential benefits.
Background:
Impact of minimized extracorporeal circulation (MECC) for coronary surgery on mortality remains controversial and gender significantly influence outcome.
Methods:
We analyzed 3,139 male patients undergoing elective coronary surgery between 01/2004 and 05/2009. Using propensity score matching after binary logistic regression, 1,005 patients (from 1,119 patients) undergoing surgery with MECC could be matched with 1,005 patients (from 2,020 patients) undergoing surgery with conventional extracorporeal circulation (CECC). Primary outcome was 30-day mortality.
Results:
Unadjusted 30-day mortality was 2.7% in patients with CECC and 0.8% in those with MECC (mean difference -1.9%; p < 0.001). The adjusted mean difference (average treatment effect of the treated) after matching was -1.5% (95% confidence interval (CI) -2.6 to -0.4; p = 0.006). Postoperative hospital stay was shorter in patients operated with minimized systems (adjusted mean difference -0.8 days; 95% CI -1.46 to -0.09; p = 0.03) and incidence of postoperative neurocognitive dysfunction was also lower (adjusted mean difference -1.3%; 95% CI -2.2 to -0.4; p = 0.001). Chest tube drainage (adjusted mean difference +22 mL; 95% CI -47 to 91; p = 0.5) and risk for acute kidney injury, kidney injury and failure according to RIFLE criteria (adjusted mean difference -1.0%; 95% CI -2.5 to 0.6; p = 0.24) proved to be insignificant between both groups. Apart from reduced 30-day mortality, however, average treatment effects for intensive care unit stay, postoperative hospital stay, chest tube drainage and kidney injury did not significantly differ.
Conclusion:
Using propensity score analysis, we observed an association between MECC and reduced 30-day mortality in men, but our results call for further analysis.
