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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2011 April;52(2):271-6
Immediate and 5-year outcome after coronary artery bypass surgery in very high risk patients (additive EuroSCORE ≥10)
Mosorin M.-A., Heikkinen J., Pokela M., Anttila V., Mosorin M., Lahtinen J., Juvonen T., Biancari F. ✉
Division of Cardio-Thoracic and Vascular Surgery Department of Surgery, Oulu University Hospital, Oulu, Finland
AIM: We have evaluated the outcome after coronary artery bypass surgery in very high risk patients (additive EuroSCORE≥10). The impact of beating heart coronary artery bypass surgery (BHCAB) on their outcome has been evaluated.
METHODS: Retrospective study including 160 consecutive patients with additive EuroSCORE≥10.
RESULTS:. The overall survival rates at 30-day, 1-year, 3-year and 5-year were 83.8%, 76.0%, 72.4% and 66.8%, respectively. Baseline cardiac index (O.R. 0.20, 95%C.I. 0.08-0.53), preoperative inotropic support (O.R. 4.55, 95%C.I. 1.41-14.73) and preoperative resuscitation (O.R. 3.937, 95%C.I. 1.02-15.26) were independent predictors of 30-day mortality. Baseline cardiac index (R.R. 0.48, 95%C.I. 0.28-0.85), left ventricular ejection fraction (P=0.032), preoperative use of intraaortic balloon pump (R.R. 3.22, 95% C.I. 1.50-6.93), preoperative tracheal intubation (R.R. 3.44, 95%C.I. 1.37-8.68) and creatinine (R.R. 1.004, 95%C.I. 1.00-1.01) were independent predictors of late death.
OPCAB/BHCAB was associated with somewhat lower 30-day mortality rate (16.2% vs. 18.0%, P=0.73), stroke (2.0% vs. 4.9%, P=0.37), red blood cells transfusion (3.4 vs. 5.4 units, P=0.004) and combined adverse outcome (43.4% vs. 50.8%, P=0.42). OPCAB/BHCAB surgeons compared with surgeons with a prevalent conventional approach achieved slightly better the 30-day mortality rate (16.7% vs. 27.9%, P=0.15) and stroke rate (2.8% vs. 4.7%, P=0.60) and 5-year survival rate (65.3% vs. 57.4%, P=0.35).
CONCLUSION: Despite their poor immediate postoperative outcome, 5-year survival of these high risk patients is satisfactory and supports efforts in the treatment of this very high risk population. A more confident approach toward OPCAB/BHCAB is also suggested in these patients.