Risk Factors For Cardiac Surgery Research Articles

Sex bias in prediction and diagnosis of cardiac surgery associated acute kidney injury

BackgroundFemale sex has been recognized as a risk factor for cardiac surgery associated acute kidney injury (CS-AKI). The current study sought to evaluate whether female sex is a risk factor for CS-AKI, or modifies the association of peri-operative change in serum creatinine with CS-AKI.MethodsObservational study of adult patients undergoing cardiac surgery between 2000 and 2019 in a single U.S. center. The main variable of interest was registered patient sex, identified from electronic medical records. The main outcome was CS-AKI within 2 weeks of surgery.ResultsOf 58526 patients, 19353 (33%) were female; 12934 (22%) incurred AKI based on ≥ 0.3 mg/dL or ≥ 50% rise in serum creatinine (any AKI), 3320 (5.7%) had moderate to severe AKI, and 1018 (1.7%) required dialysis within 2 weeks of surgery. Female sex was associated with higher risk for AKI in models that were based on preoperative serum creatinine (OR, 1.35; 95% CI, 1.29–1.42), and lower risk with the use of estimated glomerular filtration, (OR, 0.90; 95% CI, 0.86–0.95). The risk for moderate to severe CS-AKI for a given immediate peri-operative change in serum creatinine was higher in female compared to male patients (p < .0001 and p < .0001 for non-linearity), and the association was modified by pre-operative kidney function (p < .0001 for interaction).ConclusionsThe association of patient sex with CS-AKI and its direction was dependent on the operational definition of pre-operative kidney function, and differential outcome misclassification due to AKI defined by absolute change in serum creatinine.

The Effect of Liver Cirrhosis on Patients Undergoing Cardiac Surgery.

The aim of this study was to investigate the impact of liver cirrhosis (LC) on postoperative complications and long-term outcomes in patients who underwent cardiac surgery. Three databases, including PubMed, Embase, and the Cochrane Library, were searched on July 24, 2022. A total of 1,535,129 patients were enrolled in the seven included studies for analysis. According to our analysis, LC was a risk factor for postoperative overall complications (OR = 1.48, 95% CI = 1.21 to 1.81, I2 = 90.35%, P = 0.00 < 0.1). For various complications, more patients developed pulmonary (OR = 1.86, 95% CI = 1.21 to 2.87, I2 = 90.79%, P = 0.00 < 0.1), gastrointestinal (OR = 2.03, 95% CI = 1.32 to 3.11, I2 = 0.00%, P = 0.00 < 0.05), renal (OR = 2.20, 95% CI = 1.41 to 3.45, I2 = 91.60%, P = 0.00 < 0.1), neurological (OR = 1.14, 95% CI = 1.03 to 1.26, I2 = 7.35%, P = 0.01 < 0.05), and infectious (OR = 2.02, 95% CI = 1.17 to 3.50, I2 = 92.37%, P = 0.01 < 0.1) complications after surgery in the LC group. As for cardiovascular (OR = 1.07, 95% CI = 0.85 to 1.35, I2 = 75.23%, P = 0.58 > 0.1) complications, there was no statistical significance between the 2 groups. As for long-term outcomes, we found that in-hospital death (OR = 2.53, 95% CI = 1.86 to 3.20, I2 = 44.58%, P = 0.00 < 0.05) and death (OR = 3.31, 95% CI = 1.54 to 5.07, I2 = 93.81%, P = 0.00 < 0.1) in the LC group were higher than the non-LC group. LC was a risk factor for cardiac surgery. Patients with LC who would undergo cardiac surgery should be fully assessed for the risks of cardiac surgery. Similarly, the surgeon should assess the patient's liver function before surgery.

Mitral annular calcification in obstructive hypertrophic cardiomyopathy: Incidence, risk factors, and prognostic value after myectomy

BackgroundMitral annular calcification (MAC) is a risk factor for cardiac surgery, but there is limited study on the prognosis value and the impact for valve function of MAC based on computed tomography (CT) diagnosis after myectomy for hypertrophic obstructive cardiomyopathy (OHCM). MethodsConsecutive OHCM patients underwent septal myectomy were compared according to the existence of MAC and its severity in preoperative CT scans. The survival data were evaluated and compared by Kaplan Meier analysis and log rank test. Cox regression analysis was used to evaluate the impact of MAC on endpoint events. ResultsFrom the entire cohort of 1035 patients, 10.8% had MAC. In multivariate regression, female (OR = 2.23), age (OR = 1.07), aortic annular calcification (OR = 2.52), aortic calcification (OR = 2.56), systolic anterior motion of the mitral valve (SAM) (OR = 0.42), mitral valve thickening (OR = 2.13), and tricuspid regurgitation (OR = 3.12) were independent predictors of MAC. All-cause mortality (3.57% vs. 1.08%, p = 0.031), major adverse cardiovascular and cerebrovascular events (MACCE) (23.32% vs. 13.65%, p = 0.014), recurrent MR > 2+ (8.04% vs. 2.49%, p = 0.001) and NYHA III-IV (11.61% vs. 5.53%, p = 0.012) were more frequent in OHCM patients with MAC after myectomy. MAC was discovered to be an independent predictor of postoperative recurrent MR > 2+ after other risk factors were taken into account (HR 2.47, 95% CI 1.08–5.67, p = 0.0329). Moderate-to-severe MAC was an independent risk factor (HR 2.03, 95% CI 1.09–3.75, p = 0.0244) for long-term major adverse cardiovascular and cerebrovascular events (MACCE). ConclusionMAC was detected in one-tenth of OHCM patients in preoperative CT scanning and is mainly associated with aging and atherosclerosis. OHCM patients with MAC had a worse prognosis and more recurrent mitral valve regurgitation than those without MAC after septal myectomy.

Propensity Matched Outcomes of Minimally Invasive Mitral Surgery: Does a Heart-Team Approach Eliminate Female Gender as an Independent Risk Factor?

There is increasing evidence that female gender is an independent risk factor for cardiac surgery. Minimally invasive mitral surgery (MIV) has proven to have excellent long-term results, but little is known about gender-dependent outcomes. The aim of our study was to analyze our heart team's decision-based MIV-specialized cohort. In-hospital and follow-up data were retrospectively collected. The cohort was divided into gender groups and propensity-matched groups. Between 22 July 2013 and 31 December 2022, 302 consecutive patients underwent MIV. Before matching, the total cohort showed that women were older, had a higher EuroSCORE II, were more symptomatic, and had more complex valve pathology and tricuspid regurgitation resulting in more valve replacements and tricuspid repairs. Intensive and hospital stays were longer. In-hospital deaths (n = 3, all women) were comparable, with more atrial fibrillation in women. The median follow-up time was 3.44 (0.008-8.9) years. The ejection fraction, NYHA, and recurrent regurgitation were low and comparable and atrial fibrillation more frequent in women. The calculated 5-year survival and freedom from re-intervention were comparable (p = 0.9 and p = 0.2). Propensity matching compared 101 well-balanced pairs; women still had fewer resections and more atrial fibrillation. During the follow-up, women had a better ejection fraction. The calculated 5-year survival and freedom from re-intervention were comparable (p = 0.3 and p = 0.3). Despite women being older and sicker, with more complex valve pathology and subsequent replacement, early and mid-term mortality and the need for reoperation were low and comparable before and after propensity matching, which might be the result of the MIV setting combined with our patient-tailored decision-making. We believe that a multidisciplinary heart team approach is crucial to optimize patient outcomes in MIV, and it might also reduce the widely reported increased surgical risk in female patients. Further studies are needed to prove our findings.

Mitral Valve Repair in Advanced Age Groups: Does Cardiac Age Differ from Chronological Age?

Advanced age is a risk factor in cardiac surgery contributing significantly to a worse outcome. The reasons are frailty and multimorbidity. In this study, we asked: Is there an aging of the heart which differs from chronological age? Propensity score matching was performed between 115 seniors ≥ 80 years and 345 juniors < 80 years. After the patients were found to be comparable in terms of cardiac and noncardiac disease and risk profiles, they were further analyzed for cardiac parameters. In addition, the seniors and juniors were compared in terms of cardiac health and postoperative outcome. Furthermore, the patients were subdivided into several age groups (<60 years, 60-69 years, 70-79 years, and >80 years) and compared regarding outcome. The seniors demonstrated significantly lower tricuspid annular plane systolic excursion (TAPSE), significantly more frequent diastolic dysfunction, significantly higher plasma levels of NT-proBNP, and significantly larger left ventricular end-diastolic and end-systolic diameters and left atrial diameters (p < 0.001, respectively). Furthermore, in-hospital mortality and most postoperative complications were significantly higher in seniors compared with juniors. While old cardiac healthy patients showed better outcome than old cardiac aged patients, the outcome from young cardiac aged patients was better than old cardiac aged patients. The outcome and survival deteriorated with increasing life decades. The elderly suffer significantly more from cardiac deterioration, i.e., cardiac aging, and show higher multimorbidity. Mortality risk is significantly higher and they suffer more often from a complicated postoperative course compared to younger patients. Further approaches to prevention and treatment of cardiac aging are needed to address the needs of an aging society.

Microspherocytic hemolytic anemia as a risk factor in cardiac surgery

Microspherocytic hemolytic anemia as a risk factor in cardiac surgery

Postoperative outcomes and risk factors for cardiac surgery in solid organ transplant recipients

Postoperative outcomes and risk factors for cardiac surgery in solid organ transplant recipients

Diabetes mellitus in transfemoral transcatheter aortic valve implantation: a propensity matched analysis

BackgroundDiabetes Mellitus (DM) affects a third of patients with symptomatic severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). DM is a well-known risk factor for cardiac surgery, but its prognostic impact in TAVI patients remains controversial. This study aimed to evaluate outcomes in diabetic patients undergoing TAVI.MethodsThis multicentre registry includes data of > 12,000 patients undergoing transfemoral TAVI. We assessed baseline patient characteristics and clinical outcomes in patients with DM and without DM. Clinical outcomes were defined by the second valve academic research consortium. Propensity score matching was applied to minimize potential confounding.ResultsOf the 11,440 patients included, 31% (n = 3550) had DM and 69% (n = 7890) did not have DM. Diabetic patients were younger but had an overall worse cardiovascular risk profile than non-diabetic patients. All-cause mortality rates were comparable at 30 days (4.5% vs. 4.9%, RR 0.9, 95%CI 0.8–1.1, p = 0.43) and at one year (17.5% vs. 17.4%, RR 1.0, 95%CI 0.9–1.1, p = 0.86) in the unmatched population. Propensity score matching obtained 3281 patient-pairs. Also in the matched population, mortality rates were comparable at 30 days (4.7% vs. 4.3%, RR 1.1, 95%CI 0.9–1.4, p = 0.38) and one year (17.3% vs. 16.2%, RR 1.1, 95%CI 0.9–1.2, p = 0.37). Other clinical outcomes including stroke, major bleeding, myocardial infarction and permanent pacemaker implantation, were comparable between patients with DM and without DM. Insulin treated diabetics (n = 314) showed a trend to higher mortality compared with non-insulin treated diabetics (n = 701, Hazard Ratio 1.5, 95%CI 0.9–2.3, p = 0.08). EuroSCORE II was the most accurate risk score and underestimated 30-day mortality with an observed-expected ratio of 1.15 in DM patients, STS-PROM overestimated actual mortality with a ratio of 0.77 and Logistic EuroSCORE with 0.35.ConclusionDM was not associated with mortality during the first year after TAVI. DM patients undergoing TAVI had low rates of mortality and other adverse clinical outcomes, comparable to non-DM TAVI patients. Our results underscore the safety of TAVI treatment in DM patients.Trial registrationThe study is registered at clinicaltrials.gov (NCT03588247).

EXAMINING THE ASSOCIATION BETWEEN DOMAINS OF FRAILTY AND 6-MONTH CHANGES IN HEALTH-RELATED QUALITY OF LIFE, LIVING STATUS, AND TREATMENT DECISIONAL REGRET AMONG OLDER PATIENTS REFERRED FOR CARDIAC SURGERY

EXAMINING THE ASSOCIATION BETWEEN DOMAINS OF FRAILTY AND 6-MONTH CHANGES IN HEALTH-RELATED QUALITY OF LIFE, LIVING STATUS, AND TREATMENT DECISIONAL REGRET AMONG OLDER PATIENTS REFERRED FOR CARDIAC SURGERY

EXAMINING THE ASSOCIATION BETWEEN DOMAINS OF FRAILTY AND 6-MONTH CHANGES IN HEALTH-RELATED QUALITY OF LIFE, LIVING STATUS, AND TREATMENT DECISIONAL REGRET AMONG OLDER PATIENTS REFERRED FOR CARDIAC SURGERY

<h3>BACKGROUND</h3> Both age and frailty function as key preoperative risk factors for cardiac surgery. Age alone is usually a poor marker for predicting older patients' health status, most likely due to failure to reflect functional status in the measurement. Frailty status, which takes function into account, may be a better measure for older patients' health status. <h3>METHODS AND RESULTS</h3> The overall goal of this research was to determine the impact of varying degrees of frailty on the functional recovery of patients who undergo cardiac surgery. Specific objectives were as follows: (1) Determine the association between domains of frailty and change in HRQoL at baseline and 6 months post-surgery, (2) Determine the association between domains of frailty and dependent living status at 6 months post-surgery (3), determine the association between domains of frailty and treatment decisional regret at 6 months post-surgery. A prospective cohort pre-post design was used to evaluate the exposure (frailty)and resulting outcomes (change in HRQoL; dependent living status; treatment decisional regret). The primary outcome was HRQoL, measured preoperatively and at 6 months using EQ-5D-3L/EQ-VAS. Secondary outcomes were, dependent living status and treatment decisional regret, measured using the Functional Independence questionnaire. Worse ADL function was positively associated with higher levels of impairment in mobility and usual function HRQoL from baseline to 6 months. As well, worse ADL function was negatively associated with greater HRQoL improvement in men as measured by index scores and across all procedure types as measured by EQ-VAS. Worse mobility function was negatively associated with higher levels of improvement in HRQoL in isolated AVR patients. Lastly, those with worse ADL function had higher odds of experiencing a dependent living status 6 months after surgery (aOR = 2.06 (1.42, 3.00)), and worse ADL (aOR = 1.89 (1.35, 2.65) and cognitive (aOR = 1.77 (1.26, 2.47) function had higher odds of regretting their decision to have surgery. <h3>CONCLUSION</h3> The current study showed domain-specific frailty, particularly poor pre-operative ADL function, is negatively associated with an individual's capacity to return to optimal HRQoL post-operatively, independent living status and positively associated with experience of decisional regret. The evidence-based data has the potential to better inform patients who are at risk for loss of HRQoL and independence with cardiac surgery, allowing them to make decisions in line with values and preferences. Educating patients these risks is an important aspect of patient-centered care and individualized decision-making based on patient priorities.

Aging as a risk factor for cardiac surgery: Blunted ischemic-reperfusion stress response?

Biological aging is commonly associated with compromised cardiovascular function. In particular, cardiac aging is featured by unfavorable left ventricular remodeling, loss of compliance, and poor contractile reserve. Among possible contributing factors for cardiovascular aging, dampened autophagy response has received much attention. Recent evidence also noted a decline in ischemia-reperfusion (I/R) response and mitochondrial content in aging. I/R stress is commonly seen in the setting of cardiac surgery representing a clinical dilemma accompanied by possible myocardial injury if not handled correctly. Although overproduction of reactive oxygen species has been indicated to play a role in aging-associated more pronounced I/R injury, little is known for the mechanism of action (in particular the role of autophagy and mitophagy) and possible sequelae of poor I/R stress response in aging.

Impact of Viral PCR Positive Nasal Swabs (Non Covid-19) on Outcomes Following Cardiac Surgery.

Viral bronchiolitis is a relative contraindication to elective pediatric cardiac surgery. Nasopharyngeal swab utilizing polymerase chain reaction (PCR) screening for viruses known to cause bronchiolitis are commonly available. The objective of this study was to evaluate clinical outcomes in patients with nasopharyngeal viral PCR positive findings at the time of cardiac surgery. Retrospective review from January 2013 to May 2019 for patients with virus detected by PCR on nasopharyngeal swabs at the time of cardiac surgery. Single ventricle and two ventricle patients were compared to control group of age and procedure matched patients viral negative at the time of surgery. Outcome measures included OR extubation, reintubation, hospital length of stay, and mortality. For two ventricle patients (n = 81; control group = 165), there was no statistical difference in any outcome variable (OR extubation 74% vs 72%; p = 0.9; reintubation 9% vs 11% vs; p = 0.7; hospital length of stay 5 days (1–46) vs 4 days (2–131); p = 0.4; mortality 2 vs 1; p = 0.3). For single ventricle patients, there was no statistical difference in any outcome variable (OR extubation 81% vs 76%; p = 0.6; reintubation 14% vs 21% vs; p = 0.5; hospital length of stay 9.5 days (3–116) vs 15 days (2–241); p = 0.1; mortality 0 vs 3; (p = 0.6)). PCR is a sensitive test that fails to predict which patients will proceed to have a clinically significant infection. Viral bronchiolitis remains a relative risk factor for cardiac surgery; presence of detectable virus via nasopharyngeal swab with limited clinical symptoms may not be a contraindication to cardiac surgery.

The Novel Use of Mechanical Circulatory Support to Demonstrate Pulmonary Hypertension Reversibility in Mitral Stenosis

<h3>Introduction</h3> Pulmonary Hypertension (PHT) presents a significant risk factor for cardiac surgery. Patients with reversible PHT have better surgical outcomes. We present a novel and successful approach to demonstrate PHT reversibility and relieve pulmonary congestion in a patient with severe mitral stenosis using extracorporeal left atrial to femoral artery bypass MCS. <h3>Case Report</h3> A 56-year-old female with a history of rheumatic mitral stenosis presented with severe pulmonary edema. Transthoracic echocardiogram demonstrated severe MS (mean valve area .5 cm2, mean gradient of 20 mmHg) with preserved left ventricular ejection fraction. TEE confirmed no thrombus formation in the left atrium. Right heart catheter exam demonstrated elevated pulmonary artery (PA) pressures of 110/80 mmHg and a wedge pressure of 40 mmHg. PHT reversibility was desired to demonstrate the benefit of surgical intervention. A simulation using pulmonary vasodilator therapy would likely exacerbate her pulmonary venous congestion; an intra-aortic balloon pump or a percutaneous left ventricular assist device would not adequately unload the pulmonary venous pressure. Extracorporeal left atrial to femoral artery bypass MCS was used to unload the left atrium directly. After MCS initiation, PHT reversibility and surgical indication was confirmed with significantly improved pulmonary pressures (Table 1). The volume status and lung congestion were optimized preoperatively. Intraoperatively, the MCS left atrial inflow cannula was pulled back into the right heart and used as a venous cannula for cardiopulmonary bypass. Successful mitral valve replacement was performed. Postoperatively, the mitral valve mean gradient was 3 mmHg. The patient was discharged home on day 15. <h3>Summary</h3> The novel use of extracorporeal MCS with left atrial to femoral arterial bypass provides a novel strategy to simulate PHT reversibility and optimization for MS surgery.

Consensus on diagnosis and treatment of perioperative pulmonary hypertension in cardiac surgery

Pulmonary hypertension (PH) is a common disease. Pulmonary hypertension caused by left heart disease (PH-LHD) and congenital heart disease related pulmonary artery hypertension (PAH-CHD) account for main parts of PH and pulmonary artery hypertension (PAH) respectively. Patients are often complicated with PH before, during and after cardiac surgery. PH can cause right heart failure, and is a high risk factor for cardiac surgery. Accurate evaluation and reasonable treatment on HP can reduce perioperative complications and mortality, hence improve prognosis. This article elaborates the consensus of Chinese experts on the definition, classification, pathophysiology, diagnosis and perioperative treatment of PH related to cardiac surgery.

Preoperative Opioid Use Disorder Is Associated With Poorer Outcomes After Coronary Bypass and Valve Surgery: A Multistate Analysis, 2007–2014

To determine the effect of preoperative opioid use disorder (OUD) on postoperative outcomes in patients undergoing coronary artery bypass grafting (CABG) and heart valve surgery. Retrospective, observational study using data from the State Inpatient Database and the Healthcare Cost and Utilization Project. Inpatient data from Florida, California, New York, Maryland, and Kentucky between 2007 and 2014. A total of 377,771 CABG patients and 194,469 valve surgery patients age ≥18 years. None. The prevalence of OUD was 2,136 (0.57%) in the CABG group and 2,020 (1.04%) in the valve surgery group. There was no significant difference in mortality between the OUD and non-OUD groups in both surgical cohorts (both p > 0.05). On adjusted analyses, preoperative OUD was significantly associated with increased adjusted odds ratios (aORs) of 30-day hospital readmission (CABG aOR 1.47 [95% confidence interval {CI} 1.30-1.66]; valve surgery aOR 1.41 [95% CI 1.27-1.56]) and 90-day hospital readmission (CABG aOR 1.47 [95% CI 1.31-1.64]; valve surgery aOR 1.33 [95% CI 1.23-1.43]). Preoperative OUD was significantly associated with increased adjusted risk ratios (aRRs) of hospital length of stay (CABG aRR 1.13 [95% CI 1.10-1.16]; valve surgery aRR 1.63 [95% CI 1.54-1.72]) and total hospitalization charges (CABG aRR 1.05 [95% CI 1.03-1.07]; valve surgery aRR 1.28 [95% CI 1.24-1.32]). Preoperative OUD is significantly associated with poorer outcomes after cardiac surgery, including increased 30- and 90-day readmissions, hospital length of stay, and total hospitalization charges. Opioid use should be considered a modifiable risk factor in cardiac surgery, and interventions should be attempted preoperatively.

Prenatal Diagnosis Influences Preoperative Status in Neonates with Congenital Heart Disease: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.

The early postnatal course for a newborn with critical congenital heart disease (CHD) can be negatively impacted if diagnosis is delayed. Despite this, there continues to be inconsistent evidence regarding potential benefits associated with prenatal diagnosis (PND) in neonates who undergo cardiac surgery. The objective of this study was to better define the impact of a PND on pre-operative morbidity by utilizing a large clinical database. Neonates (< 30days) undergoing heart surgery from 2010 to 2014 and entered in the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) were included. Multivariable logistic regression was used to evaluate the association between PND and a composite measure including nine major pre-operative risk factors. Co-variates were included to adjust for important patient characteristics (e.g., weight-for-age z-score, genetic syndromes, prematurity), case complexity, and center effects. Centers and patients with excess missing data for relevant co-variates were excluded. Included were 12,899 neonates undergoing surgery at 112 centers. Major pre-operative risk factors were present in 34% overall. By univariate analysis, PND was associated with a lower overall prevalence of major pre-operative risk factors. After adjusting for potential confounders, major pre-operative risk factors were less prevalent among neonates with PND compared to neonates without PND (adjusted OR 0.62, 95% CI 0.57-0.68, p < 0.001). A sensitivity analysis excluding neonates with genetic syndromes, non-cardiac anatomic abnormalities, and prematurity demonstrated similar findings (adjusted OR 0.55, 95% CI 0.49-0.61, p < 0.0001). Among neonates with CHD, prenatal diagnosis is associated with significantly lower rates of pre-operative risk factors for cardiac surgery. Further studies are needed to define association of these pre-operative benefits of a PND with longer term clinical outcomes.

Frequency of Complications Including Death from Coronary Artery Bypass Grafting in Patients With Hepatic Cirrhosis

Advanced liver disease is a risk factor for cardiac surgery. However, liver dysfunction is not included in cardiac risk assessment models. We sought to identify trends in utilization, complications, and outcomes of patients with cirrhosis who underwent coronary artery bypass graft surgery (CABG). Using the National Inpatient Sample database, we identified patients with cirrhosis who underwent CABG from 2002 to 2014. Propensity-score matching was used to identify differences in in-hospital mortality and postoperative complications in cirrhosis and noncirrhosis patients. We identified a total of 698,799 CABG admissions of which 2,231 (0.3%) had cirrhosis (mean age 63.6 ± 9.6 years, 74% men, 63% white, mean Charlson co-morbidity index 3.3 ± 1.8). Cardiopulmonary bypass was used in 71% of patients. Mean length of stay was 13.7 ± 11.4 days and hospitalization cost $67,744.6 ± 58,320.4. One or more complications occurred in 44% of cases. After propensity-score matching, patients with cirrhosis had a higher rate of complications (43.9% vs 38.93%; p < 0.001) and in-hospital mortality (7.2% vs 4.07%; p < 0.001) than noncirrhosis patients. On multivariate analysis, cirrhosis and ascites were associated with increased in-hospital mortality (odds ratio 2.87; 95% confidence intervals 2.37 to 3.48) and postoperative complications (odds ratio 5.11; 95% confidence intervals 3.88 to 6.72). In conclusion, patients with cirrhosis constitute a small portion of patients who underwent CABG in the United States but have a higher rate of complications and in-hospital mortality compared with noncirrhosis patients. In-hospital mortality remains high for this subset of patients but has decreased in recent years.

Higher Age and Lower BMI Are Stronger Predictors of Mortality For Females Than Males on VA ECMO

Gender is a known risk factor for cardiac surgery. The impact of gender is unknown in patients undergoing Veno-Arterial Extracorporeal- Membrane Oxygenation (VA ECMO). This study aims to delineate clinical and biological risk factors in male vs. female patients undergoing VA ECLS.

Preoperative asymptomatic leukocytosis and postoperative outcome in cardiac surgery patients.

BackgroundDespite showing a prognostic value in general surgical patients, preoperative asymptomatic elevated white blood cell (WBC) count is not considered a risk factor for cardiac surgery. Whereas there is sporadic evidence of its value as a preoperative risk marker, it has not been looked at methodically as a specific index of outcome during cardiac surgery. Using a national database we sought to determine the relationship between preoperative WBC count and postoperative outcome in cardiac surgical patients.MethodsCardiac surgeries were extracted from the 2007–2013 American College of Surgeons National Surgical Quality Improvement Program database. Leukocytosis was defined by a preoperative WBC count greater than 11,000 cells/μL. A univariate analysis compared the incidence of adverse outcomes for patients with and without leukocytosis. A multivariate logistic regression model was constructed in order to test whether leukocytosis was an independent predictor of morbidity and mortality.ResultsOut of a total of 10,979 cardiac surgery patients 863 (7.8%) had preoperative leukocytosis. On univariate analysis, patients with leukocytosis experienced greater incidences of 30-day mortality, wound complications, and medical complications. Wound complications included surgical site infection as well as wound dehiscence. The medical complications included all other non-surgical causes of increased morbidity and infection leading to urinary tract infection, pneumonia, ventilator dependence, sepsis and septic shock. After stepwise model adjustment, leukocytosis was a strong predictor of medical complications (OR 1.22, 95% CI: 1.09–1.36, p = 0.002) with c-statistic of 0.667. However, after stepwise model adjustment leukocytosis was not a significant predictor of 30-day mortality and wound complications.ConclusionPreoperative leukocytosis is associated with adverse postoperative outcome after cardiac surgery and is an independent predictor of infection-related postoperative complications.

Risikofaktoren für perioperativen Retinaarterienverschluss in der Herzchirurgie

Calway T et al. Perioperative retinal artery occlusion: risk factors in cardiac surgery from the United States National Inpatient Sample 1998 – 2013. Ophthalmology 2017; 124: 189 – 196