Heart Surgery Mortality Research Articles

Nanotechnology: Potential Applications in Cardiothoracic Surgery

Within the last several years dramatic changes have occurred in the field of cardiothoracic surgery permitting new and evolving technologies to be applied to the benefit of patients. One of these is the field of less invasive heart surgery. The principle causes of morbidity and mortality in conventional open heart surgery are related to the use of the heart/lung bypass machine and the sternal splitting incision. In response to this problem surgeons developed the MIDCAB or minimally invasive direct coronary artery bypass operation. The da Vinci™ computer-enhanced surgical robotic system has been used at the Ohio State University Medical Center to harvest the internal mammary artery from patients who were undergoing MIDCAB. The same system can be also applied to introduce novel biomedical engineering nanotechnology. In this article we described the nature and use for this innovative technology that undoubtedly will have dramatc impact on the future of cardiac patients and heart care.

Assessing open heart surgery mortality in Catalonia (Spain) through a predictive risk model.

To develop a risk stratification model to assess open heart surgery mortality in Catalonia (Spain) in order to use risk-adjusted hospital mortality rates as an approach to analyze quality of care. Data were prospectively collected through a specific data-sheet during 6 1/2 months in consecutive adult patients subjected to open heart surgery. The dependent variable was surgical mortality, and independent variables included were presurgical (sociodemographic data, clinical antecedents, morphological and functional studies) and surgical. The model was built on a subsample (70% of study population) through univariate and logistic regression analysis and validated in the rest of the sample. The total sample was of 1309 procedures in seven hospitals; 47% of them were valve procedures. The overall crude mortality rate was 10.9% and varied among centers (range, 2.8-14.8%). Risk factors included in the model received a weight based on the logistic regression coefficient and a score was generated for each patient. The factors with the highest weight were patient older than 80 and second reoperation. Score was stratified in five categories of increasing risk. There was a good agreement between observed and predicted mortality rates in the validation group. Overall patient distribution was as follows: 52% low risk level, 16% fair, 13% high, 12% very high, and 6% extremely high risk level. Mortality rate increased from 4.2% in the low risk to 54.4% in the highest risk group. Case mix adjustment was performed through the risk score level. There were statistically significant differences in the risk profiles of patients admitted among centers. After adjustment by risk profiles, there were no differences in mortality by hospital. A risk stratification model through a multicentric, prospective and exhaustive collection of data in all types of open heart procedures was developed. In spite of wide differences on crude rates and in the risk profiles of patients admitted, we did not find statistically significant differences in adjusted mortality rates among centers. Timely and accurate information about surgical outcomes can lead to improvements in clinical practice and quality of care.

In-Hospital Mortality for Surgical Repair of Congenital Heart Defects: Preliminary Observations of Variation by Hospital Caseload

To examine the impact of hospital caseload on in-hospital mortality for pediatric congenital heart surgery. Population-based, retrospective cohort study. Acute care hospitals in California and Massachusetts. Children undergoing surgery for congenital heart disease, identified by the presence of procedure codes indicating surgical repair of a congenital heart defect in computerized statewide hospital discharge abstract databases. Cases were grouped into four categories based on the complexity of the procedure. Adjusted odds ratios (OR) for in-hospital death were estimated using generalized estimating equations that account for the intra-institutional correlation among patients. A total of 2833 cases at 37 centers were identified. Compared with centers performing > 300 cases per year, after controlling for patient characteristics, centers performing < 10 cases per year had an OR for in-hospital death of 7.7 (95% confidence interval (CI) [1.6-37.8]); 10 to 100 cases, OR = 2.9 (95% CI [1.6-5.3]); 101 to 300 cases, OR = 3.0 (95% CI [1.8-4.9]). Independent risk factors for mortality included procedure complexity category (P < .0001), use of cardiopulmonary bypass (P < .0001), young age at surgery (P = .001), and transfer from another acute care hospital (P < .0001). Few differences were found by hospital caseload in length of stay or total hospital charges. For children with a congenital heart defect who underwent surgery in California in 1988 or Massachusetts in 1989, the risk of dying in-hospital was much lower if the surgery was performed at an institution performing > 300 cases annually. This study was limited by the absence of clinical detail in discharge abstract databases. If these findings are corroborated by other studies, health care delivery strategies that direct children requiring surgical correction of congenital heart defects to high-volume centers may substantially reduce overall mortality.

Are Arrhythmias a Marker for Perioperative Mortality in Heart Surgery?

Are Arrhythmias a Marker for Perioperative Mortality in Heart Surgery?