Wstęp: Powszechnie uważa się, że kobiety poddawane izolowanemu pomostowaniu aortalno-wieńcowemu (CABG) są obarczone większym ryzykiem okołooperacyjnych powikłań i zgonu. Cel: Celem badania była ocena wpływu płci jako czynnika ryzyka wczesnych powikłań i śmiertelności po izolowanym CABG w krążeniu pozaustrojowym oraz ocena profilu ryzyka warunkowanego przez płeć pacjenta. Metody: Analizie poddano dane pochodzące z wszystkich 2194 zabiegów wykonanych w Klinice Kardiochirurgii Uniwersytetu Medycznego w Łodzi w okresie między styczniem 2009 a marcem 2011 roku. Dla celów badania skonstruowano bazę danych opartą na retrospektywnej analizie zmiennych zawartych w formularzach Krajowego Rejestru Operacji Kardiochirurgicznych. Wyniki: Izolowane CABG w krążeniu pozaustrojowym wykonano u 1303 pacjentów (59,4% wszystkich zabiegów). Kobiety stanowiły mniejszość (24,2%) i były starsze od mężczyzn (średni wiek 67,3 vs . 62,8 roku; p < 0,001). Istotnie częściej chorowały na cukrzycę (43,1% vs . 33,41%, p = 0,003), charakteryzowały się gorszą funkcją nerek (mediana eGFR 88,5 vs . 95,0 ml/min/1,73 m2; p < 0,001) oraz rzadziej paliły tytoń (54,1% vs . 83,0%; p < 0,001). Tętnicę piersiową wewnętrzną rzadziej wykorzystywano jako pomost w grupie kobiet (84,8% vs . 95,0%; p < 0,001). Kobiety były obarczone wyższym ryzykiem wystąpienia ostrego zawału pooperacyjnego (5,5% vs . 2,9%; p = 0,03) oraz rzadziej wymagały reoperacji (4,5% vs . 8,1%; p = 0,04). Wśród kobiet zaobserwowano wyższą śmiertelność 30-dniową (7,6% vs . 2,8%; p < 0,001), a płeć żeńska w analizie wieloczynnikowej regresji logistycznej okazała się niezależnym predyktorem zgonu (OR = 1,8; 95% CI 1,2–2,7). Wnioski: Kobiety poddawane izolowanemu CABG charakteryzują się wyższą śmiertelnością 30-dniową. Płeć żeńska jest niezależnym czynnikiem ryzyka zgonu po izolowanym CABG. Należy przeprowadzić kolejne badania w celu identyfikacji przyczyn odmienności w rokowaniu wśród kobiet.
Coronary artery bypass grafting (CABG) is conducted more and more commonly in patients in advanced age.To analyze the influence of age and concurrent risk factors on the complications and early mortality after CABG.Medical records of 2194 patients were analyzed retrospectively. A group of 1303 patients who had undergone isolated CABG was selected. 106 (4.8%) patients were excluded due to missing data in their medical records. The remaining 1197 patients were divided into two subgroups by age: 1(st) group < 65 years (n = 662; 55.3%); 2(nd) group ≥ 65 years (n = 535; 44.7%).The total 30-day mortality was 3.93% and was six times higher in the older group (1.21 vs. 7.29%; p < 0.001). Complications were observed in 176 (14.70%) patients, more often in the older group (10.42% vs. 20.0%; p < 0.001). In this group all kinds of complications were noted more often and in particular: postoperative myocardial infarction (1.96% vs. 5.42%; p = 0.001), respiratory dysfunction (1.36% vs. 4.11%; p = 0.005), neurological complications (1.81% vs. 3.74%; p = 0.04) and multi-organ dysfunction syndrome (0.30% vs. 1.68%, p = 0.03). The older patients required longer time under mechanical ventilation (24.0 ± 27.9 vs. 37.0 ± 74.1 hours; p = 0.004) and stayed longer in the intensive care unit: 2.5 ± 3.0 vs. 4.1 ± 7.84 days; p < 0.001. Independent predictors of death were: female sex [OR (95% CI) = 2.4 (1.2-4.5)], age ≥ 65 years [OR = 4.9 (2.1-11.1)], eGFR < 60 mL/min/1.73 m(2) [OR = 2.2 (1.0-4.7)], time at extracorporeal circulation > 72 minutes [OR = 5.5 (2.7-10.9)] and left main stem stenosis (> 50%) [OR = 2.4 (1.3-4.6)].Age still significantly influences postoperative complications and mortality after isolated CABG.Pomostowaniu aortalno-wieńcowemu (PAW) w ostatnich latach poddawani są pacjenci w coraz bardziej zaawansowanym wieku.Ocena wpływu wieku i współistniejących czynników ryzyka na wystąpienie powikłań pooperacyjnych oraz wczesną śmiertelność pooperacyjną po izolowanym PAW.Retrospektywnie przeanalizowano dokumentację medyczną 2194 pacjentów. Wyselekcjonowano grupę 1303 zabiegów izolowanego PAW. Z analizy wykluczono pacjentów bez kompletnego zestawu danych klinicznych (n = 106; 4,8%). Pozostałych 1197 pacjentów podzielono na dwie podgrupy według wieku: grupa 1 – osoby < 65. roku życia (n = 662; 55,3%); grupa 2 – osoby ≥ 65. roku życia (n = 535; 44,7%).Śmiertelność 30-dniowa wyniosła 3,93% i była ponad 6-krotnie wyższa u osób starszych (1,21 vs 7,29%; p < 0,001). Powikłania wystąpiły ogółem u 176 (14,70%) pacjentów, częściej u osób w starszej grupie wiekowej (10,42% vs 20,0%; p < 0,001). W tej grupie odnotowano również większą częstość występowania wszystkich rodzajów powikłań, w szczególności: świeżego pooperacyjnego zawału serca (1,96% vs 5,42%; p = 0,001), powikłań oddechowych (1,36% vs 4,11%; p = 0,005), powikłań neurologicznych (1,81% vs 3,74%; p = 0,04) oraz niewydolności wielonarządowej (0,30% vs 1,68%; p = 0,03). Starsi pacjenci wymagali dłuższego mechanicznego wspomagania wentylacji (24,0 ± 27,9 vs 37,0 ± 74,1 godz.; p = 0,004) oraz dłużej przebywali na oddziale intensywnej opieki medycznej (2,5 ± 3,0 vs 4,1 ± 7,84 dnia; p < 0,001). Niezależnymi predyktorami zgonu były: płeć żeńska [OR (95% CI) = 2,4 (1,2–4,5)], wiek ≥ 65 lat [OR = 4,9 (2,1–11,1)], eGFR < 60 ml/min/1,73 m2 [OR = 2,2 (1,0-4,7)], czas trwania krążenia pozaustrojowego > 72 minut [OR = 5,5 (2,7–10,9)] oraz obecność zwężenia pnia lewej tętnicy wieńcowej (> 50%) [OR = 2,4 (1,3–4,6)].Wiek wciąż istotnie wpływa na śmiertelność i częstość występowania powikłań po izolowanym PAW.
The heart is the rarest site for neoplasms to be localized.Despite modern diagnostic techniques, cardiac tumours continue to among those discovered latest and with the worst prognoses.We present the case of a 62-year-old woman with a heart tumour and mediastinal lymphadenopathy, who was admitted to the Department of Cardiac Surgery.The patient underwent surgical removal of the tumour with extracorporeal circulation.The left atrium, mitral valve and the left ventricle were occupied by the infiltration.A radical resection appeared to be impossible.A valvular prosthesis was not implanted.The perioperative period was uncomplicated.On the 9 th day a local recurrence was confirmed in the transthoracic echocardiography.Further oncological diagnostics revealed the spread of the malignant neoplasm to bones of the pelvis and spine.Chemotherapy was initiated.The authors discuss the most appropriate diagnostic and treatment procedures employed in the above case.
Preoperative atrial fibrillation is one of the predictors of increased morbidity and mortality in patients undergoing surgical revascularization, and consequently, prolongs the duration of stay in the ICU and of overall hospitalization.The study included 3000 patients subjected to primary isolated coronary artery bypass grafting from 2000 to 2004. Of the 3000 patients, 5.8 % (n = 174) had electrocardiographically documented, preoperative atrial fibrillation. To evaluate the relationship between preoperative AF and postoperative outcome, all patients were observed for about three years.Patients with preoperative atrial fibrillation were older (P < 0.05), had a lower ejection fraction (P < 0.001), a higher incidence of heart failure (P < 0.001), hypertension (P < 0.001), and more coexistent morbidities including diabetes (P < 0.05), obturative pulmonary disease (P < 0.0001) and mild renal failure (P < 0.001). Statistical analysis showed that survival rates at 6 and 30 days, 6 and 12 months, and 3 years following surgical revascularization of patients with vs. those without preoperative atrial fibrillation were: 96.4% vs. 98.1%, and 94.5% vs. 97.3% (P = ns), 86.2% vs. 93.0% (P < 0.03), and 74.7% vs. 91.0% (P < 0.02), and 70.7% vs. 90.6% (P < 0.01). After 3 years' observation there was a survival difference of 19.9%. We showed that preoperative atrial fibrillation triple increased the risk of postoperative AF and was an independent risk factor for in-hospital death (P < 0.001).Preoperative atrial fibrillation is a predictor of postoperative complications, including death, and of a significant reduction in patients' long-term survival. Patients with preoperative atrial fibrillation should be considered as high-risk patients with potential postoperative complications and should be well protected with antiarrhythmic and anticoagulant therapy.
Surgical re-exploration due to postoperative bleeding that follows coronary artery surgery is associated with significant morbidity and mortality. The aim of this study was to assess a relationship between re-exploration, major postoperative complications, in-hospital mortality and mid-term outcomes in patients following coronary surgery, on the basis of nationwide registry data.We identified all consecutive patients enrolled in Polish National Registry of Cardiac Surgical Procedures (KROK Registry) who underwent isolated coronary surgery between January 2012 and December 2014. Preoperative data, major postoperative complications, hospital mortality and mid-term all-cause mortality were, respectively, analysed. Comparisons were performed in all patients, low-risk patients (EuroSCORE II < 2%, males, aged 60-70 years) and propensity-matched patients. The starting point for follow-up was the date of hospital discharge.Among 41 353 analysed patients, 1406 (3.4%) underwent re-exploration. Reoperated patients had more comorbidities, more frequent major postoperative complications, higher in-hospital mortality (13.2% vs 1.8%, P < 0.001) and higher mid-term mortality in survivors (P < 0.001). In the low-risk population, 3.0% of patients underwent re-exploration. Reoperated low-risk patients and propensity-matched patients also had more frequent major postoperative complications and higher in-hospital mortality, but mid-term mortality in survivors was similar. In a multivariable analysis, re-exploration was an independent predictor of death and all major postoperative complications.Surgical re-exploration due to postoperative bleeding following coronary artery surgery carries a high risk of perioperative mortality and is linked to major postoperative complications. Among patients who survive to hospital discharge, mid-term mortality is associated primarily with preoperative comorbidities.
Background: EuroSCORE is used to predict postoperative mortality in patients undergoing cardiac surgery. Its updated version was published in 2011. Aim: To assess whether EuroSCORE II (ESII) predicts more accurately postoperative mortality after cardiac surgery in comparison with additive (addES) and logistic EuroSCORE (logES). Methods: A total of 461 patients (aged 21–88 years, 63.4% of men) who underwent cardiac surgery (December 2010 – June 2011) were included into the prospective research. For each patient ESII, addES and logES were calculated. Accuracy, calibration, and clinical performance of these models were assessed with receiver operating characteristics analyses using the area under the curve and the Hosmer-Lemeshow test. Out of this population, a group of 300 coronary artery bypass grafting (CABG) patients (aged 42–85 years, 73% of men) was selected and statistically analysed using the same methods. Results: The mortality rate was 5.21%. Predicted mortality rates were as follows: addES 4.68%, logES 4.57%, and ESII 1.89%; the accuracy was: 0.589, 0.728, and 0.726, respectively. Only logES presented good predictive power (Hosmer-Lemeshow test: c2 = 12.79, p = 0.12). In the CABG patients, the postoperative mortality rate was 5.33%. Predicted mortality rates were as follows: addES 4.69%, logES 4.59%, and ESII 1.88%; the accuracy was: 0.512, 0.691, and 0.687, respectively. In the Hosmer-Lemeshow test also logES presented good predictive power (c2 = 10.72, p = 0.218). Conclusions: EuroSCORE II did not estimate mortality risk better in comparison to its previous versions, in the entire studied population or in the CABG patients. On the basis of the analysed data, it seems that the closest to the actual risk of death for the Polish population is the EuroSCORE logistic model.
