Impact of Severe Postoperative Complications after Cardiac Surgery on Mortality in Patients Aged over 80 Years

Kamiya, Hiroyuki; Tanzeem, Nadine; Akhyari, Payam; Pedraza, Anabel; Kallenbach, Klaus; Lichtenberg, Artur; Kretzler, Matthias

doi:10.5761/atcs.oa.13-02268

Cited by 18 publications

(11 citation statements)

References 11 publications

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“…There are also some studies related to the relationship between the development of systemic inflammatory response syndrome and cardiopulmonary bypass revealed that increased RDW is associated with increased systemic inflammatory response (15). Systemic inflammatory response syndrome is related to increased mortality in patients undergoing CABG surgery (16). Elevated RDW is also associated with increased risk of the other morbid conditions such as development of new onset atrial fibrillation, ischemic stroke and sepsis (17,18).…”

Section: Discussionmentioning

confidence: 99%

The Red Cell Distribution Width is Strong Predictor for the in-Hospital Mortality of the CABG Patients

Katlandur¹,

Özdil²,

Özbek³

et al. 2016

Acta Med Anatol

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Introduction:There are several studies about the mortality of the CABG patients with the importance of the inflammation. The aim of our study was to evaluate the relationship between RDW and in-hospital mortality in CABG patients.Methods: A total of 346 patients undergoing coronary artery bypass grafting operation were analyzed for our study. Preoperative 2 ml blood sample was put into tubes for evaluation all patients complete blood count. All patients underwent same anesthesia protocol. The type of CABG procedure (off-pump vs on-pump CABG) was determined by the operation team. Results:There was ten patients died in-hospital period (Group 1) and three hundred and thirty-six patients lived during in hospital follow up (Group 2). WBC (10.8 ± 5.2 x 103 vs 7.9 ± 2.2 x 103 p: 0.04), Neutrophil (7.3 ± 3 x 103 vs 5.1 ± 2 x 103 p: 0.03), N/L Ratio (4.8 ± 2.6 % vs 2.7 ± 1.6 % p: 0.01) and RDW (14.8 ± 1.6 % vs 13.9 ± 6.6 %, p: 0.002) values were higher in group 1 than group 2, respectively. A logistic multivariate regression analysis showed that only RDW (OR 1.860, 95% CI 1.105-3.132; p: 0.02) was an independent predictor of the development of mortality in-hospital period in CABG patients. Conclusion:To our knowledge, this is the first report of an association between RDW and the development postoperative mortality in CABG patients. Keywords:Red cell distribution width, In-Hospital mortality, Coronary artery bypass grafting. Received: 02.03.2016 Accepted: 08.04.2016 doi: 10.5505/actamedica.2016 AbstractThe Red Cell Distribution Width is Strong Predictor for the in-Hospital Mortality of the CABG Patients

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Section: Discussionmentioning

confidence: 99%

The Red Cell Distribution Width is Strong Predictor for the in-Hospital Mortality of the CABG Patients

Katlandur¹,

Özdil²,

Özbek³

et al. 2016

Acta Med Anatol

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“…However, more than two-thirds of all cardiac surgical procedures do not involve inborn cardiac malformations in the young but aortocoronary bypass grafts and valve replacements in elderly patients. These patients also have a substantial probability to develop severe impairments like neurological complications (disorientation, transient ischemic attacks, and stroke), renal failure with the necessity of dialysis, or lung disorders with prolonged artificial ventilation (Alexander et al, 2000 ; Boldt et al, 2003 ; Reis Miranda et al, 2005 ; Kamiya et al, 2014 ). It should be mentioned that stroke and TIA may be attributed to clots embolizing the A. cerebri media area and disorientation probably is the consequence of global low flow ischemia affecting the water-shed region of hippocampus.…”

Section: Introductionmentioning

confidence: 99%

Strategies for Pharmacological Organoprotection during Extracorporeal Circulation Targeting Ischemia-Reperfusion Injury

Salameh

Dhein

2015

Front. Pharmacol.

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Surgical correction of congenital cardiac malformations or aortocoronary bypass surgery in many cases implies the use of cardiopulmonary-bypass (CPB). However, a possible negative impact of CPB on internal organs such as brain, kidney, lung and liver cannot be neglected. In general, CPB initiates a systemic inflammatory response (SIRS) which is presumably caused by contact of blood components with the surface of CPB tubing. Moreover, during CPB the heart typically undergoes a period of cold ischemia, and the other peripheral organs a global low flow hypoperfusion. As a result, a plethora of pro-inflammatory mediators and cytokines is released activating different biochemical pathways, which finally may result in the occurrence of microthrombosis, microemboli, in depletion of coagulation factors and haemorrhagic diathesis besides typical ischemia-reperfusion injuries. In our review we will focus on possible pharmacological interventions in patients to decrease negative effects of CPB and to improve post-operative outcome with regard to heart and other organs like brain, kidney, or lung.

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“…17,32 The need for tracheostomy may complicate cardiac surgery with an incidence ranging from 3.9% to 5.7% according to the type of surgery, and an increased risk of mortality, especially in the elderly. 33 At least 85% of the weaned subjects of our study underwent cannula removal and tracheostomy closure. The clinical relevance of cannula removal at discharge is supported by a study showing that lack of decannulation of conscious tracheostomized subjects before ICU discharge to the general ward was associated with higher mortality.…”

Section: Discussionmentioning

confidence: 99%

Outcomes for Difficult-to-Wean Subjects After Cardiac Surgery

et al. 2014

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BACKGROUND:The need for prolonged mechanical ventilation (PMV) after cardiac surgery is still a common problem. We hypothesized that subjects who required PMV after a single surgery (either coronary artery bypass grafting or valve surgery) would have better outcomes than those who had experienced both revascularization and valve surgery. METHODS: We retrospectively analyzed the characteristics and outcomes for patients consecutively admitted to our weaning unit (WU) after cardiac surgery between December 2007 and August 2012. Subjects' data were analyzed according to the number of procedures. Group 1 included subjects who had undergone a single surgery (valvular replacement or myocardial revascularization). Group 2 included subjects who had undergone combined surgery (valvular replacement and myocardial revascularization). Data for PMV subjects who were transferred to the WU for reasons other than cardiac surgery in the same period are also reported. RESULTS: Of 584 PMV subjects admitted, 35 (5.9%, 19 in group 1 and 16 in group 2) were referred after cardiac surgery. At WU admission, group 2 showed significantly more comorbidities and a greater clinical severity than group 1. Compared with group 1, group 2 showed a significantly lower weaning rate (43.7% vs 78.9%, P ‫؍‬ .003) and a higher in-hospital mortality (31.3% vs 5.3%, P ‫؍‬ .04). The overall 6-month survival for subjects of group 1 was 73.7% compared with 37.5% for subjects in group 2 (P ‫؍‬ .02). Adjusting for comorbidities and clinical severity, the difference between the 2 groups did not reach statistical significance for either the weaning rate or the overall 6-month survival. At discharge, health status, as assessed by means of functional independence measure, was significantly better in group 1 than in group 2 (P ‫؍‬ .035). CONCLUSIONS: These results suggest that patients needing PMV after combined cardiac surgery may suffer worse outcomes than those needing PMV after simple cardiac surgery.

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Impact of Severe Postoperative Complications after Cardiac Surgery on Mortality in Patients Aged over 80 Years

Cited by 18 publications

References 11 publications

The Red Cell Distribution Width is Strong Predictor for the in-Hospital Mortality of the CABG Patients

The Red Cell Distribution Width is Strong Predictor for the in-Hospital Mortality of the CABG Patients

Strategies for Pharmacological Organoprotection during Extracorporeal Circulation Targeting Ischemia-Reperfusion Injury

Outcomes for Difficult-to-Wean Subjects After Cardiac Surgery

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