The changing face of cardiac surgery patients: an insight into a Mediterranean region

Abstract

Data of 9 years of surgical activity (on about 10000 patients), obtained from the database of our cardiac surgery care centre, were analysed to assess time-related variations in demographics, clinical and surgical characteristics. Data of patients submitted to major cardiac surgery procedures between 1999 and 2007 were examined using the chi-square test, analysis of variance (ANOVA) test or non-parametric tests, where applicable. The 'linear-by-linear' association test was used to verify the existence of a time-related trend. A value of p<0.05 was considered significant. In the time interval of 9 years, there was an increment of valve procedures and a decrease in coronary revascularisation surgery. Patients aged 75 years or more at the time of operation increased from 17% in 1999 to 29% in 2005, and the percentage of patients aged 80 or more demonstrated a threefold increase. Operated patients had more co-morbidity (the rate of hypertension rate 43.7% in 1999 and 68.9% in 2007, and obese patients were 13% in 1999 and 17.5% in 2007) and had worse functional and cardiac status (reduced ejection fraction (EF), haemodynamic instability and shock). As a consequence, there was an increased calculated surgical risk. At the same time, there was no significant increment in the observed mortality (3.1% in 1999 vs 3.8% in 2007 for all patients and 1.6% compared with 1.5% in isolated coronary artery bypass graft (CABG) patients). These changes can reflect both a variation in the characteristics of the population and a major evolution in intervention cardiology and also impose more intensive and extensive postoperative treatment and less invasive cardiac surgery practice.