Failure to achieve a satisfactory cardiac outcome after isolated coronary surgery in low-risk patients

Author:

Rubino Antonino S1ORCID,Nicolini Francesco2ORCID,Tauriainen Tuomas3,Demal Till4,De Feo Marisa1,Onorati Francesco5,Faggian Giuseppe5ORCID,Bancone Ciro1ORCID,Perrotti Andrea6,Chocron Sidney6,Dalén Magnus78,Santarpino Giuseppe910,Fischlein Theodor9ORCID,Maselli Daniele11ORCID,Musumeci Francesco12,Santini Francesco13,Salsano Antonio13ORCID,Zanobini Marco14,Saccocci Matteo14ORCID,Bounader Karl15,Gatti Giuseppe16ORCID,Ruggieri Vito G17,Mignosa Carmelo18,Juvonen Tatu319,Mariscalco Giovanni20,Biancari Fausto31921ORCID

Affiliation:

1. Division of Cardiac Surgery, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy

2. Division of Cardiac Surgery, University of Parma, Parma, Italy

3. Department of Surgery, Oulu University Hospital and Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland

4. Hamburg University Heart Center, Hamburg, Germany

5. Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy

6. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France

7. Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

8. Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

9. Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany

10. Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy

11. Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy

12. Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy

13. Division of Cardiac Surgery, University of Genoa, Genoa, Italy

14. Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy

15. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France

16. Cardio-Thoracic and Vascular Department, Trieste University Hospital, Trieste, Italy

17. Division of Thoracic and Cardiovascular Surgery, Robert Debré University Hospital, Reims, France

18. Cardiothoracic Department, ISMeTT/UPMC, Palermo, Italy

19. Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland

20. Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK

21. Department of Surgery, University of Turku, Turku, Finland

Abstract

Abstract OBJECTIVES This study aims to investigate the incidence and determinants of major early adverse events in low-risk patients undergoing isolated coronary artery bypass grafting (CABG). METHODS The multicentre E-CABG registry included 7352 consecutive patients who underwent isolated CABG from January 2015 to December 2016. Patients with an European System for Cardiac Operative Risk Evaluation (EuroSCORE) II of <2% and without any major comorbidity were the subjects of the present analysis. RESULTS Out of 2397 low-risk patients, 11 (0.46%) died during the index hospitalization or within 30 days from surgery. Five deaths were cardiac related, 4 of which were secondary to technical failures. We estimated that 8 out of 11 deaths were potentially preventable. Logistic regression model identified porcelain aorta [odds ratio (OR) 34.3, 95% confidence interval (CI) 1.3–346.3] and E-CABG bleeding grades 2–3 (OR 30.2, 95% CI 8.3–112.9) as independent predictors of hospital death. CONCLUSIONS Mortality and major complications, although infrequently, do occur even in low-risk patients undergoing CABG. Identification of modifiable causes of postoperative adverse events may be useful to develop preventative strategies to improve the quality of care of patients undergoing cardiac surgery. Clinical Trial Registration NCT02319083 (https://clinicaltrials.gov/ct2/show/NCT02319083).

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,Surgery

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