Analysis of mortality in low-risk patients undergoing coronary artery bypass grafting : cardiovascular topic

Abstract

AimThe aims of this study were to determine the early mortality rate in low-risk coronary artery bypass graft (CABG) patients and examine the causes of death, to identify problems that could be avoided in future surgeries.MethodsAll low-risk patients (EuroSCORE ≤ 2) who died after CABG were included. Their peri-operative information was meticulously studied by internal and independent external reviewers to identify causes of death, which were classified as: cardiac or non-cardiac; and a further division as: (1) non-preventable, (2) preventable (technical error), and (3) preventable (system error).ResultsEarly mortality was 0.93% (24/2 570). Eleven patients (45.8%) were classified as preventable deaths. In six of them the main problem was identified as graft thrombosis, which was secondary to a technical error of either the harvesting or anastomosis of the left internal mammarian artery. There were also five system errors identified as delays in the treatment of an identified and potentially reversible problem.ConclusionsCorrection of technical and system errors, such as harvesting of the left internal mammarian artery, haemostasis during surgery, and establishing standard protocols for the transfer of patients from ward to intensive care units will eventually lead to improvement in both the quality of care and patient outcomes, even in low-risk groups.

Mortality in low- and very low-risk patients undergoing cardiac surgery: Evaluation according to the EuroSCORE II as a new standard

“…Table 3 summarizes the findings of different studies analyzing death in low-risk patients and virtually 3 of them (from United Kingdom [3,4] and Sweden [5]) showed mortality rates well below 1%. The remaining 2 studies from Turkey reported similar results to ours, though they only included coronary artery bypass grafting that has a well-known lower risk of operative mortality than other types of open heart surgery [6,7].…”

“…Perioperative death in low-risk patients is uncommon and had not been thoroughly studied until recently [3][4][5][6][7]. Previous studies defined low--risk with a logistic EuroSCORE ≤ 2 or an additive EuroSCORE ≤ 3, and investigated whether death could be considered preventable due to a technical or system error.…”

“…Though surgical performance was adequate according to this new Yes -system Potential problem with anticoagulation CABG -coronary artery bypass grafting; A-V -atrioventricular; AVR -aortic valve replacement; MI -myocardial infarction risk model standard, we found that there is still some room for improvement, since over half of deaths were potentially preventable. In previous studies, some unforeseen events such as stroke or mediastinitis were usually presumed to be nonpreventable [6]. However, a stroke could arise from aortic debris embolism during cross-clamping or from air embolism in open heart surgery, and in these situations, the event might be considered preventable.…”

“…To date, only a few reports have analyzed the outcomes in low-risk patients, and in every case risk has been calculated based on a logistic Euro-SCORE ≤ 2 [3][4][5][6][7]. Since this original EuroSCORE overestimates operative risk [8], we developed this study to prospectively evaluate the immediate results of cardiac surgery in patients with an expected mortality risk ≤ 2% according to the EuroSCORE II as a new gold-standard.…”

Death in low-risk cardiac surgery revisited

“…Inspired by the FIASCO study, we undertook a similar analysis at our institution and reported the Stockholm experience almost 10 years ago. 5 Since then a study from Turkey was published 6 including low-risk patients undergoing coronary artery bypass grafting surgery. The authors of the original FIASCO study repeated the analysis some years later and published the results of the FIASCO II study.…”