Abstract
BackgroundImpact of minimized extracorporeal circulation (MECC) for coronary surgery on mortality remains controversial and gender significantly influence outcome.MethodsWe 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.ResultsUnadjusted 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.ConclusionUsing propensity score analysis, we observed an association between MECC and reduced 30-day mortality in men, but our results call for further analysis.
Highlights
Impact of minimized extracorporeal circulation (MECC) for coronary surgery on mortality remains controversial and gender significantly influence outcome
Before matching the mean propensity score (PS) for MECC use in men operated with conventional ECC (n = 2,020) was 0.3281 ± 0.1142 and in those receiving Coronary artery bypass grafting (CABG) with MECC 0.3914 ± 0.1145 with an associated standardized difference of 55%
We used propensity score matching to estimate for the first time the treatment effect of MECC for CABG in a large sample of men
Summary
Impact of minimized extracorporeal circulation (MECC) for coronary surgery on mortality remains controversial and gender significantly influence outcome. Coronary artery bypass grafting (CABG) with conventional extracorporeal circulation (CECC) remains the treatment of choice, in particular, for multivessel disease [1,2]. Gender significantly impacts outcome after CABG and women were shown to have increased mortality and morbidity even after risk adjustment [8]. The reasons for gender-related differences in outcome after CABG surgery still remain controversial and vastly unknown, but agreement exists on strong gender-related bias in observational trials [9].
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