Predictors and Outcomes of Cardiac Complications Following Elective Coronary Bypass Grafting

Abstract

Our objective was to determine the predictors of cardiac complications among a cohort of elective coronary artery bypass graft (CABG) surgery patients and to determine the relationship of such complications to subsequent quality of life and symptoms. A total of 248 patients were enrolled and 237 completed 6 month follow-up. The combined rate of both major and minor cardiac complications was 9.7% (n = 24). Patients in this study were evaluated preoperatively, monitored intraoperatively, followed immediately postoperatively and at 6 months. Major cardiac complications accounted for 3.6% (n = 9) and minor complications for 6% (n = 15). Using multivariable logistic regression analysis, the predictors of major cardiac complications were receiving diuretics preoperatively (p = .01) and increased time during cross-clamping (p = .006). At 6 months after surgery, 19% of the patients with postoperative cardiac complications experienced worsening of symptoms, in contrast to only 8% of those without cardiac complications (p = .03). We concluded that patients who were on preoperative diuretics and those who had longer cross-clamp times were at higher risk of cardiac complications. The majority of patients who had acute cardiac complications had improved function and symptoms at 6 months postoperatively.

Evidence-Based Renal Protection in Cardiac Surgery

“…[73][74][75] In contrast to evidence from animal experiments, several clinical studies have shown no benefit, and possibly even harm, from perioperative diuretic therapy in cardiac surgery patients: [76][77][78] • In a cohort of 248 coronary artery bypass graft (CABG) surgery patients, Charlson and colleagues found that preoperative diuretic therapy was an independent risk factor for postoperative complications. 79 • In a double-blind, randomized-controlled trial comparing infusions of furosemide, low-dose dopamine, or placebo from the start of surgery to 48 hours postoperative or intensive care unit discharge in 126 cardiac surgery patients, Lassnig and colleagues found no benefit of dopamine and a greater postoperative increase in serum creatinine in the group that received furosemide. These authors concluded that furosemide was detrimental to renal function after cardiac surgery.…”