The impact of symptom severity on cardiac reoperative risk: early referral and reoperation is warranted

Ngaage, Dumbor L.; Cowen, Michael E.; Griffin, Steve; Guvendik, Levant; Cale, Alexander R.
October 2007
European Journal of Cardio-Thoracic Surgery;Oct2007, Vol. 32 Issue 4, p623
Academic Journal
Abstract: Background: Operative mortality is comparatively higher for coronary artery bypass grafting (CABG) or valve reoperations. Studies of reoperative risk have focussed on surgical techniques. We sought to determine the risk and predictors of poor outcome in current practice, and the influence of preoperative symptoms. Method: For every redo patient (n =289), we selected the best-matched pair of patients who underwent a primary operation (n =578) between 1998 and 2006. Matching variables were age, gender, left ventricular ejection fraction (LVEF) and type of operation. Poor outcome was defined as operative mortality or major morbidity. Result: Median age was 68 (interquartile range 62–73) years and 28% were female for both groups. Severe symptoms and cardiac morbidity dominated the presentation of redo patients. CABG (53%), valve repair/replacement (34%) and combined CABG and valve (12%) were performed with overall operative mortality of 6.6% (median additive EuroScore 7.0) for redo versus 1.6% (median additive EuroScore 4.0) for primary groups (p <.0001). Whereas no significant difference was observed between primary (1.6%) and redo CABG (3.9%, p =.19), valve reoperations had higher operative mortality (9.6% vs 1.5%, p <.0001). Major complications occurred more frequently after redo valve compared to primary valve operations (28% vs 14%, p =.001). Reoperation (odds ratio [OR] 1.26, 95% confidence interval [CI] 0.66–2.42, p =.48) was not a predictor of major adverse event after CABG or valve surgery. Determinants of poor outcome after valve reoperations were New York Heart Association class III/IV (OR 6.86, 95% CI 2.29–12.11, p =.03), duration of extracorporeal circulation (OR 1.17, 95% CI 1.02–1.35, p =.03) and mitral valve replacement (OR 4.07, 95% CI 1.83–36.01, p =.04). The predictors of major adverse events after redo CABG were congestive heart failure (OR 1.85, 95% CI 1.04–8.98, p =.006) chronic obstructive pulmonary disease (OR 17.5, 95% CI 1.87–35.21, p =.05) and interval from prior surgery (OR 1.37, 95% CI 1.09–1.92, p =.01). Conclusion: In the current era, redo CABG is nearly as safe as the primary operation. A valve reoperation, on the contrary, is higher risk due, partly, to severe symptoms at presentation. Patients should be referred and operated on early before they develop severe symptoms.


Related Articles

  • To revascularize or not to revascularize: a dilemma in heart failure. Senior, Roxy // CMAJ: Canadian Medical Association Journal;8/15/2006, Vol. 175 Issue 4, p372 

    The article studies the difficult situation of opting revascularization as a treatment to heart failure. Despite the advances in other fields of medicine, the treatment for severe heart troubles remains poor. The cardiac resynchronization therapy has been recently introduced as a treatment...

  • Aortopopliteal Bypass: A Case Report. Sfeir, Roger E.; Hussein, Maher K. // Vascular Surgery;Jun1990, Vol. 24 Issue 5, p350 

    Extraanatomic bypasses were introduced by Blaisdell more than twenty-five years ago. A wide variety of such bypasses have been used in various conditions. The authors report a case of aortopopliteal bypass done for limb salvage.

  • Trial Scorecards.  // Cardiology Today;Nov2008, Vol. 11 Issue 11, p10 

    The article presents summaries of important cardiology trials in the U.S. In comparing cardiovascular (CV) or cerebrovascular event rates for coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI), the PCI group showed revascularization rate of 13.7% and the CABG group...

  • IMAGES IN CARDIOLOGY: Transient pericardial effusion after cardiac surgery: often unrecognised. Bonclarenko, O.; Knaapen, P.; van Rossum, A. C. // Heart;Sep2005, Vol. 91 Issue 9, p1212 

    This article presents the case study of a 52 year-old man with ischaemic heart failure. He was evaluated with cardiovascular magnetic resonance imaging (CMR), before coronary artery bypass surgery (CABG), and demonstrated a dilated left ventricle with depressed ejection fraction. Surgery was...

  • Urocortins: Take Them to Heart. Scarabelli, Tiziano; Knight, Richard // Current Medicinal Chemistry - Cardiovascular & Hematological Age;Oct2004, Vol. 2 Issue 4, p335 

    The urocortins, together with corticotropin releasing hormone (CRH), have a long evolutionary pedigree. In the brain, CRH largely mediates anxiogenic effects associated with the stress response, while the urocortins are concerned with adaptive and coping behaviour. The urocortins, in particular,...

  • Early invasive strategy in elderly patients with non- ST elevation acute coronary syndrome: comparison with younger patients regarding 30 day and long term outcome. Liistro, F.; Angioli, P.; Falsini, G.; Ducci, K.; Baldassarre, S.; Burali, A.; Bolognese, L. // Heart;Oct2005, Vol. 91 Issue 10, p1284 

    Objectives: To evaluate an early invasive strategy in elderly patients with non-ST elevation acute coronary syndrome (ACS). Methods: All consecutive patients admitted with a diagnosis of non-ST elevation ACS from June 2002 to February 2004 were enrolled in this registry. Clinical outcome was...

  • Left ventricular reconstruction benefits patients with ischemic cardiomyopathy and non-viable myocardium Ribeiro, Gustavo Aguiar; da Costa, Cledicyon Eloy; Lopes, Mauricio M.; Albuquerque, Ana Nunes; Antoniali, Fernando; Reinert, Gleice Agnes A.; Franchini, Kleber G. // European Journal of Cardio-Thoracic Surgery;Feb2006, Vol. 29 Issue 2, p196 

    Abstract: Objective: There are subsets of patients with ischemic cardiomyopathy for whom the optimal treatment strategies are not clear. The objective of this study was to delineate the relationship between clinical outcomes and surgical procedure in patients who were treated either with a...

  • Three-year outcomes after percutaneous coronary intervention and coronary artery bypass grafting in patients with heart failure: from the CREDO-Kyoto percutaneous coronary intervention/coronary artery bypass graft registry cohort-2†. Marui, Akira; Kimura, Takeshi; Nishiwaki, Noboru; Komiya, Tatsuhiko; Hanyu, Michiya; Shiomi, Hiroki; Tanaka, Shiro; Sakata, Ryuzo // European Journal of Cardio-Thoracic Surgery;Feb2015, Vol. 47 Issue 2, p316 

    OBJECTIVES Ischaemic heart disease is a major risk factor for heart failure. However, long-term benefit of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in those patients has not been well elucidated. METHODS Of the 15 939 patients undergoing first myocardial...

  • Outcome after redo coronary artery bypass grafting in patients with ischaemic cardiomyopathy and viable myocardium. Rizzello, V.; Poldermans, D.; Schinkel, A. F. I.; Biagini, E.; Boersma, E.; Elhendy, A.; Sozzi, F. B.; Palazzuoli, A.; Maat, A.; Crea, F.; Bax, J. J. // Heart;Feb2007, Vol. 93 Issue 2, p221 

    Background: Repeat coronary artery bypass grafting (redo-CABG) in patients with ischaemic cardiomyopathy is associated with high perioperative risk and worse long-term outcome compared with patients undergoing their first CABG. Objective: To assess whether patients with viable myocardium...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics