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Is Reoperation Still a Risk Factor in Coronary Artery Bypass Surgery?

Sabik, Joseph F. ; Blackstone, Eugene H. ; Houghtaling, Penny L. ; Walts, Peter A. ; Lytle, Bruce W.

The Annals of thoracic surgery, 2005-11, Vol.80 (5), p.1719-1727 [Periódico revisado por pares]

New York, NY: Elsevier Inc

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Título:
Is Reoperation Still a Risk Factor in Coronary Artery Bypass Surgery?
Autor: Sabik, Joseph F. ; Blackstone, Eugene H. ; Houghtaling, Penny L. ; Walts, Peter A. ; Lytle, Bruce W.
Assuntos: Aged ; Biological and medical sciences ; Cardiology. Vascular system ; Coronary Artery Bypass ; Coronary Disease - classification ; Coronary Disease - complications ; Coronary Disease - therapy ; Coronary heart disease ; Female ; Heart ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Registries ; Reoperation - adverse effects ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the respiratory system
É parte de: The Annals of thoracic surgery, 2005-11, Vol.80 (5), p.1719-1727
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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Descrição: Hospital mortality for reoperative coronary artery bypass grafting (CABG) is approaching that of primary CABG. This raises two questions: (1) has experience neutralized the risk of reoperation attributable to its greater difficulty, or (2) has experience neutralized the risk attributable to the higher-risk profile of reoperative patients? From 1990 to 2003, 21,568 CABG procedures were performed, of which 4,518 (21%) were reoperations: 3,919 first, 552 second, 43 third, 3 fourth, and 1 fifth. Reoperative patients had a higher-risk profile than primary patients, with more vascular disease, left ventricular dysfunction, and coronary artery disease (all p < 0.0001). Logistic regression was used to identify factors associated with hospital death and to develop a propensity score for reoperation, which was used to (1) adjust multivariable analyses of death and (2) compare outcomes in matched patients. Hospital mortality was 4.3% (168 of 3,919) for first reoperation, 5.1% (28 of 552) for second, and 6.4% (3 of 47) for third or more, compared with 1.5% (263 of 17,050) for primary operations. Risk of both primary and reoperative CABG decreased with experience (p > 0.0002); however, reoperative risk fell markedly in the mid-1990s. In both the overall and matched-pairs analyses, reoperation was a risk factor before 1997 (p ≤ 0.008), but not after (p = 0.2). Reoperation within 1 year of previous CABG increased risk (p < 0.0001). Risk attributable to left ventricular dysfunction decreased with experience (p = 0.05). Hospital mortality for reoperative CABG has been consistently higher than for primary operation, but this difference has narrowed considerably. Patient characteristics, not reoperation itself, now have greater influence.
Editor: New York, NY: Elsevier Inc
Idioma: Inglês

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Is Reoperation Still a Risk Factor in Coronary Artery Bypass Surgery?

Sabik, Joseph F. ; Blackstone, Eugene H. ; Houghtaling, Penny L. ; Walts, Peter A. ; Lytle, Bruce W.

New York, NY: Elsevier Inc

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