Background
Methods
Study design
Surgical procedures
Variable | Study group (n = 91) | Matched patients (n = 113) | P value |
---|---|---|---|
Preoperative characteristics
| |||
Age (years) | 65.4 (25–68) | 65.4 (29–84) | 0.99 |
Gender (M) | 60 (65%) | 73 (64%) | 0.13 |
Height (cm) | 163 (147–184) | 163 (143–192) | 0.64 |
Weight (kg) | 72.31 (48.8–114) | 74 (44.2–135.5) | 0.39 |
BMI | 27.07 (17.5–41.7) | 27.5 (16–43.06) | 0.52 |
BSA | 1.8 (1.43–2.32) | 1.82 (1.35–2.58) | 0.35 |
Diabetes | 32 (35%) | 31 (27%) | 0.36 |
Hypertension | 66 (72%) | 85 (75%) | 0.64 |
Dyslipidemia | 34 (37%) | 45 (40%) | 0.66 |
Chronic Renal Failure | 10 (11%) | 12 (10%) | 1 |
Smoking | 0.94 | ||
Nonsmoker | 49 (54%) | 55 (49%) | |
Current smoker | 15 (16%) | 25 (22%) | |
Former smoker | 27 (30%) | 33 (29%) | |
Family history of stroke | 19 (21%) | 29 (26%) | 0.52 |
Bilateral ICA stenosis < 50% | 52 (57%) | 9 (8%) |
<.001
|
Bilateral ICA stenosis of any grade | 63 (69%) | 17 (15%) |
<.001
|
Surgical Procedure
| |||
CABG | 25/91 (27%) | 29/113 (26%) | 0.77 |
Valve operations | 14/91 (15%) | 26/113 (23%) | 0.17 |
Aortic valve repair/replacement | 5 | 12 | |
Mitral valve repair/replacement | 9 | 14 | |
Complex procedures | 16/91 (18%) | 28/113 (24%) | 0.21 |
CABG + Aortic surgery | 4 | 7 | |
Combined aortic, mitral and tricuspid valve | 4 | 9 | |
Heart transplantation | 3 | 7 | |
LVAD | 3 | 3 | |
Left ventricular aneurysmectomy | 1 | 1 | |
Repair of post-infarction VSD | 1 | 1 | |
Aortic procedures | 24/91 (27%) | 25/113 (22%) | 0.48 |
Ascending aorta surgery | 5 | 7 | |
Aortic arch surgery | 2 | 5 | |
Combined procedure | 10 | 7 | |
Aortic root surgery | 3 | 3 | |
Valve operation + Aortic procedure | 3 | 1 | |
CABG + Aortic procedure | 1 | 2 | |
Re-do Operation | 12/91 (13%) | 5/113 (5%) |
0.02
|
Surgical Details
| |||
CBP time (minutes) | 111.11 (0–257) | 99.12 (0–257) | 0.10 |
Aortic clamp time (minutes) | 77.67 (0–216) | 71.47 (0–197) | 0.28 |
Hypothermic circulatory arrest | 25 (27%) | 17 (15%) |
0.02
|
On-pump CABG with beating heart | 7 (7%) | 3 (3%) | 0.10 |
Off-pump CABG | 4 (4%) | 6 (5%) | 0.2 |
Number of distal anastomoses (from 1 to 5) | 40 (44%) | 44 (39%) | 0.3 |
Intraoperative hemofiltration | 3 (3%) | 2 (2%) | 0.07 |
Complicated weaning from CPB | 12 (13%) | 5 (4%) |
0.02
|
Cardioplegia delivery | |||
Anterograde | 70 (77%) | 86 (76%) | 0.12 |
None | 11 (12%) | 9 (8%) | |
Anterograde+selective | 7 (8%) | 12 (11%) | |
Anterograde+ retrograde | 3 (3%) | 6 (5%) | |
Cardioplegia carrier | |||
Crystalloid | 8 (10%) | 3 (3%) |
0.02
|
Blood | 72 (90%) | 110 (97%) | |
Cardiac rhythm at sternal closure | |||
Sinus | 37 (41%) | 61 (54%) |
0.04
|
Non sinus (AF, AVB, PM) | 54 (59%) | 52 (46%) | |
Defibrillation required at weaning | 23 (25%) | 23 (20%) | 0.31 |
Surgery time (minutes) | 152.24 (21–368) | 132.08 (35–660) | 0.07 |
Intra-aortic balloon pump | 9 (10%) | 9 (8%) | 0.62 |
Post-operative data
| |||
Severe hypotension | 20 (22%) | 25 (22%) | 0.86 |
Need for vasoactive drugs | 55 (60%) | 54 (48%) |
0.03
|
Transfusion of red blood cells (units) | 2 (2–15) | 1.6 (0–22) | 0.26 |
Transfusion of plasma (units) | 1.75 (0–18) | 1.34 (0–27) | 0.32 |
Transfusion of platelets (units) | 3.1 (0–22) | 2.34 (0–20) | 0.21 |
Risk factors
ICA Doppler US and analysis
ICA | Population | Normal | < 50% | 50–70% | > 70% to near occlusion | Occlusion | |
---|---|---|---|---|---|---|---|
Right
|
Study (n = 91)
| 14 (15.4%) | 70 (77%) | 3 (3.3%) | 3 (3.3%) | 1 (1%) | |
Matched (n = 113)
| 90 (79.7%) | 17 (15%) | 2 (1.8%) | 3 (2.6%) | 1 (0.9%) | ||
Left
|
Study (n = 91)
| 15 (16.5%) | 72 (79.2%) | – | 3 (3.3%) | 1 (1%) | |
Matched (n = 113)
| 95 (84%) | 16 (14.2%) | 1 (0.9%) | 1 (0.9%) |