Preoperative prediction of early mortality and morbidity in coronary bypass surgery

Wouters, Stijn; Noyez, Luc; Verheugt, Freek W.A.; Brouwer, René M.H.J.

doi:10.1016/s0967-2109(02)00081-9

Cited by 23 publications

(14 citation statements)

References 10 publications

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“…As a consequence, the total duration of hospital stay was similar to that reported by other studies (8.3 and 7.3 days) 24,25 .…”

Section: Arq Bras Cardiol 2006; 87 : 410-415supporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

“…This index can be easily obtained and reproduced, regardless of the ventricular geometry, which makes it adequate for the assessment of the overall ventricular function in several clinical situations 10,11 . The index is defined as the sum of the isovolumetric contraction time and isovolumetric relaxing time divided by the ejection time through the Doppler analysis at the mitral inflow and the left ventricular outflow velocity and time [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] , being considered a possible assessment factor for total cardiac function and cardiac prognosis predictor 10,12,13 . Several studies have evaluated MPI in patients with acute myocardial infarction, miocardiopathy, and valvar disease among others, and the index presented an elevated prediction power for the development of unfavorable outcomes 10,[13][14][15][16][17][18]26 .…”

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confidence: 99%

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Valor prognóstico do índice de performance miocárdica no pós-operatório de cirurgia de revascularização miocárdica

Azzolin¹,

Castro²,

Feier³

et al. 2006

Arq. Bras. Cardiol.

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objective: Myocardial Performance Index (MPI) obtained by Doppler echocardiography for the non-geometrical evaluation of systolic and diastolic function has been described as a method for prognostic evaluation in patients with acute myocardial infarction (AMI). Using the same condition, the objective of this study was to evaluate the predictive value of MPI for cardiovascular complications in patients at low risk during the postoperative period of CABG. Methods:Eighty patients submitted to CABG with adequate left ventricular function in the preoperative period were studied, with MPI measured during the first hours postoperatively. Patients were followed until hospital discharge. Statistical analysis included Chi-Square test, Student t test, Mann-Whitney test, and estimation of relative risks with 95% confidence intervals, sensitivity and specificity plus a ROC curve. results:The data were evaluated by two independent observers blinded to the clinical data with non-significant intra and interobserver variability. MPI=0.43 was found as the cutoff point, considering patients with a higher probability of postoperative events those who had MPI above 0.43. The relevant events for analysis were AMI (RR 0.87 ci 0.21-3.65), atrial fibrillation (RR 0.65 ci 0.24 -1.76), other arrhythmias (RR 1.51 ci 0.36-6.33), LV dysfunction (RR 1.74 ci 0.32-9.88), with no association between patients with MPI>0.43 and the occurrence of these events. conclusion:No association was found between MPI and cardiovascular complications and longer hospital stay in this group of patients, and this index was considered not adequate as an isolated predictive method.Key words: Coronary artery bypass graft, low risk, morbidity, myocardial performance index (MPI) and prognostic outcome.The post-surgical morbimortality of coronary artery bypass graft (CABG) surgery is of great interest, resulting in several protocols of post-operative management and risk models aiming at decreasing cardiovascular complications 1 .The presence of left ventricular dysfunction and cardiac failure in the postoperative period of CABG has been considered one of most important independent predictive factors of surgical mortality [2][3][4][5] , with an association between the severity of the left ventricular dysfunction and risk of complications (4% to 10% for moderate to severe ventricular dysfunction) 3 .Cardiac surgery complications in patients with adequate left ventricular function in the pre-operative period have a low prevalence 2 ; therefore, they are hardly studied. In this group, the identification of alterations in the overall function of the left ventricle in the immediate post-operative period would allow early interventions, resulting in lower surgical morbimortality 6,7 .Non-invasive measurements of time intervals used for the assessment of the systolic and diastolic functions were proposed by Mancini 8 through phonomechanocardiography and reintroduced by Tei et al 9 in 1995 and showed to be easily obtained by conventional Doppler, with time intervals, combining...

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“…As a consequence, the total duration of hospital stay was similar to that reported by other studies (8.3 and 7.3 days) 24,25 .…”

Section: Arq Bras Cardiol 2006; 87 : 410-415supporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Valor prognóstico do índice de performance miocárdica no pós-operatório de cirurgia de revascularização miocárdica

Azzolin¹,

Castro²,

Feier³

et al. 2006

Arq. Bras. Cardiol.

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“…Several risk models such as the Cleveland model, EuroSCORE, CORRADscore, and Parsonnet model have been developed originally to predict postoperative morbidity and mortality of patients undergoing cardiac surgery [1][2][3]. High preoperative risk scores have been associated with longer LOSH and increased total costs in coronary artery bypass surgery [4].…”

Section: Introductionmentioning

confidence: 99%

Predictive Model for Length of Stay in Intensive Care Unit Based on Preoperative and Perioperative Variables. Four-Year Analysis of Mitral Valve Surgery in One Single Center

Carmona¹

2016

JACCOA

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Submit Manuscript | http://medcraveonline.com IntroductionThe cost of intensive care unit (ICU) stay is very high for patients after cardiac surgery in all settings. The costs of cardiac valve surgery depends mainly on the expenses of the operation and length of hospital (LOSH) and ICU (LOSI) stay.As ICUs are the most expensive part during hospital admission, it is important to assess which are the risk factors contributing to a prolonged stay in the ICU. Several risk models such as the Cleveland model, EuroSCORE, CORRADscore, and Parsonnet model have been developed originally to predict postoperative morbidity and mortality of patients undergoing cardiac surgery [1][2][3]. High preoperative risk scores have been associated with longer LOSH and increased total costs in coronary artery bypass surgery [4]. Those scores have been successfully validated also for prediction of prolonged LOSI. Parsonnet model and EuroSCORE were superior in identifying patients with prolonged LOSI [5].Predicting LOSI after mitral valve surgery is challenging due to the wide spectrum of comorbidities these patients sustain, and to the cardiovascular procedures and potential complications related to the surgical procedures. In addition, patients with a AbstractStudy objective: Assessing length of stay in Intensive Care Units (LOSI) after mitral valve surgery is challenging due to wide spectrum of comorbidities and cardiovascular procedures. The study aim was to elaborate a predictive model in order to identify risk factors and to predict the expected resources consumption for better monitoring for both patients and caregivers.Design: Retrospective study of prospectively collected data in the period 2009-2013. Setting: University teaching hospital.Patients: We studied all consecutive adult patients (≥ 18 years) who underwent elective mitral valve surgery. We enrolled 212 patients. Measurements:The outcome variable was LOSI. Comorbidities, postoperative morbidity and mortality were collected during the perioperative period. Multivariate analysis was used and data were studied as an additive model to assess the associations between the variables and correlations between them. A generalized additive model was fitted with least squared means estimated by the additive model due the non linearity of Euroscore I. Histograms of the residuals were examined visually to assess the fit of the models above. The model was selected using the statistical software R. Results:Median LOSI was 4 days (Interquantile range 2 to 4 days). The model for LOSI includes: infection post surgery (p<0.05), cardiogenic shock (p<0.05), Euroscore I (p<0.05), valvular replacement (p<0.05), double valvular disease (p<0.05) and associated tricuspid valve repair (p<0.05). The adjusted r squared for this model was 0.74, which implies a high predictive value for LOSI. In this model the ponderate weights for the main variables were 36.3% for infection post surgery, 15.2% for aortic clamp time, 6.9% for cardiogenic shock and 5.4% for the Euroscore I. Conclusion:Longer LOSI is st...

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“…Numerous studies have attempted to identify risk factors for patients undergoing cardiac surgery [1][2][3][4][5][6][7][8][9][10]. Knowing the risk is important to patients to determine whether the risk of surgery is personally acceptable to them.…”

Section: Introductionmentioning

confidence: 99%

Validation of a Preoperative Risk Model for Pneumonia in Patients undergoing CABG Surgery

SV¹

2014

J Nov Physiother

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Background: Postoperative pulmonary complications (PPCs) are among the most frequently reported complications of Coronary Artery Bypass Graft (CABG) surgery. However, the risk to develop a PPC is not the same for all patients. The aim of this study was to validate a previously developed preoperative six-factor pulmonary risk model (age>70 years; productive cough, smoking, diabetes mellitus, inspiratory vital capacity > 75% predicted and maximum expiratory mouth pressure>75% predicted) to predict pneumonia, in patients undergoing CABG surgery.

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Preoperative prediction of early mortality and morbidity in coronary bypass surgery

Cited by 23 publications

References 10 publications

Valor prognóstico do índice de performance miocárdica no pós-operatório de cirurgia de revascularização miocárdica

Valor prognóstico do índice de performance miocárdica no pós-operatório de cirurgia de revascularização miocárdica

Predictive Model for Length of Stay in Intensive Care Unit Based on Preoperative and Perioperative Variables. Four-Year Analysis of Mitral Valve Surgery in One Single Center

Validation of a Preoperative Risk Model for Pneumonia in Patients undergoing CABG Surgery

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