Objective Coronary artery bypass grafting (CABG) is the operation most commonly performed by cardiac surgeons. There are few contemporary data examining evolving patient characteristics and surgical ...outcomes of isolated CABG. We used the Society of Thoracic Surgeons adult cardiac surgery database to characterize trends in patient characteristics and outcomes after CABG over the past decade. Methods From 2000 to 2009, 1,497,254 patients underwent isolated primary CABG at Society of Thoracic Surgeons participating institutions. Demographics, operative characteristics, and postoperative outcomes were assessed, and risk-adjusted outcomes were calculated. Results Compared with the year 2000, patients undergoing isolated primary CABG in 2009 were more likely to have diabetes mellitus (33% vs 40%) and hypertension (71% vs 85%). There were clinically insignificant differences in age, gender, and body surface area. Between 2000 and 2009, there has been a 6.3% and 19.5% increase in the preoperative use of aspirin and beta-blockers, respectively. Between 2004 and 2009, there was a 7.8% increase in the use of angiotension-converting enzyme inhibitors preoperatively. Furthermore, between 2005 and 2009 there was a 3.8% increase in the use of statins preoperatively. The median number of distal anastomoses performed was unchanged between 2000 and 2009 (3; interquartile range, 2–4). There was a significant increase in the use of the internal thoracic artery (88% in 2000 vs 95% in 2009). The predicted mortality rates of 2.3% were consistent between 2000 and 2009. The observed mortality rate over this period declined from 2.4% in 2000 to 1.9% in 2009 representing a relative risk reduction of 24.4%. The incidence of postoperative stroke decreased significantly from 1.6% to 1.2%, representing a risk reduction of 26.4%. There was also a 9.2% relative reduction in the risk of reoperation for bleeding and a 32.9% relative risk reduction in the incidence of sternal wound infection. Conclusions Over the past decade, the risk profile of patients undergoing CABG has changed, with fewer smokers, more diabetic patients, and better medical therapy characterizing patients referred for surgical coronary revascularization. The left internal thoracic artery is nearly universally used and outcomes have improved substantially, with a significant decline in postoperative mortality and morbidity.
Commentary: MAC attack Kaneko, Tsuyoshi; Aranki, Sary F.
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
July 2023, 2023-07-00, 20230701, Letnik:
166, Številka:
1
Journal Article
Commentary: Resection of cardiac paragangliomas: All roads lead to Texas Harloff, Morgan; Bedeir, Kareem; Aranki, Sary F.
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
July 2022, 2022-07-00, 20220701, Letnik:
164, Številka:
1
Journal Article
Commentary: The future of a former valve: Inspiring, resilient, or both? Percy, Edward; Harloff, Morgan; Aranki, Sary F.
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
11/2021, Letnik:
162, Številka:
5
Journal Article
Pulmonary embolectomy is often indicated for central pulmonary embolism (PE) with hemodynamic instability, but remains controversial for hemodynamically stable patients with signs of right ...ventricular dysfunction. Because thrombolytic therapy is often contraindicated postoperatively, we reviewed risk factors and outcomes of pulmonary embolectomy for stable and unstable central PE, particularly in the early postoperative period.
Between October 1999 and September 2013, 115 patients underwent pulmonary embolectomy for central, hemodynamically unstable PE (49 of 115, 43%) or hemodynamically stable PE (56 of 115, 49%). Ten operations for alternate indications (right atrial mass, endocarditis) were excluded for comparison analysis, leaving 105 patients.
Mean age was 59 ± 13 years; 46 of 105 patients (44%) had recent surgery (within 5 weeks): orthopedic (12 of 46, 25%), neurosurgery (11 of 46, 24%), or general surgery (10 of 46, 22%). Preoperative demographics did not differ between groups, except for the frequency of cardiopulmonary resuscitation among unstable patients (11 of 49, 22%) versus stable patients (0 of 56, 0%; p < 0.001). Operative mortality for the combined groups was 6.6% (7 of 105): unstable 10.2% (5 of 49) versus stable 3.6% (2 of 56; p = 0.247). Of 11 patients requiring preoperative cardiopulmonary resuscitation, 4 died. Six-month, 1-year, and 3-year survival rates were, respectively, 75%, 68.4%, and 65.8% for unstable PE, and 92.6%, 86.7%, and 80.4% for stable PE (p = 0.018).
This large series of pulmonary embolectomies demonstrates excellent early and late survival rates for patients with stable PE and unstable PE. These findings confirm pulmonary embolectomy as a beneficial therapeutic option for central PE, especially during the postoperative period when thrombolytic therapy is often contraindicated.
Abstract Objective We hypothesized that increased postgraduate surgical experience correlates with improved operative efficiency and long-term survival in standard cardiac surgery procedures. Methods ...Utilizing a prospectively collected retrospective database, we identified patients who underwent isolated coronary artery bypass grafting (CABG) (n = 3726), aortic valve replacement (AVR) (n = 1626), mitral valve repair (n = 731), mitral valve replacement (MVR) (n = 324), and MVR + AVR (n = 184) from January 2002 through June 2012. After adjusting for patient risk and surgeon variability, we evaluated the influence of surgeon experience on cardiopulmonary bypass and crossclamp times, and long-term survival. Results Mean surgeon experience after fellowship graduation was 16.0 ± 11.7 years (range, 1.0-35.2 years). After adjusting for patient risk and surgeon-level fixed effects, learning curve analyses demonstrated improvements in cardiopulmonary bypass and crossclamp times with increased surgeon experience. There was marginal improvement in the predictability ( R2 value) of cardiopulmonary bypass and crossclamp time for CABG with the addition of surgeon experience; however, all other procedures had marked increases in the R2 following addition of surgeon experience. Cox proportional hazard models revealed that increased surgeon experience was associated with improved long-term survival in AVR (hazard ratio HR, 0.85; P < .0001), mitral valve repair (HR, 0.73; P < .0001), and MVR + AVR (HR, 0.95; P = .006) but not in CABG (HR, 0.80; P = .15), and a trend toward significance in MVR (HR, 0.87; P = .09). Conclusions In cardiac surgery, not including CABG, surgeon experience is an important determinant of operative efficiency and of long-term survival.
The utility of intraoperative transesophageal echocardiography (TEE) for different types of cardiac surgical procedures has not been thoroughly investigated despite its increasing popularity. ...Therefore, we retrospectively evaluated the impact of before and after cardiopulmonary bypass (CPB) TEE on surgical decisions in 12,566 consecutive patients undergoing cardiac surgery at a single institution.
We analyzed all patients undergoing cardiac surgical procedures who had an intraoperative TEE examination between 1990 and 2005 at the Brigham and Women's Hospital. Results of the TEE examinations were entered into a database. Previously undiagnosed TEE findings from the pre- and post-CPB examinations that directly impacted surgical decisions were evaluated.
Before and after CPB TEE examinations influenced surgical decision making in 7.0% and 2.2%, respectively, of all evaluated patients (n = 12,566). In patients undergoing only coronary artery bypass graft surgery (CABG n = 3,835), surgical decisions were influenced by 5.4% of the pre-CPB and 1.5% of the post-CPB TEE examinations, and in 6.3% and 3.3%, respectively, of those patients undergoing isolated valve procedures (n = 3,840). In combined CABG and valve procedures (n = 2,944), surgical decisions were influenced by 12.3% of the pre-CPB and 2.2% of the post-CPB TEE examinations.
Intraoperative TEE influences cardiac surgical decisions in more than 9% of all patients in the presented study population, with the greatest observed impact in patients undergoing combined CABG and valve procedures.
No rat poison for me Kaneko, Tsuyoshi; Aranki, Sary F.
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
November 2017, 2017-11-00, Letnik:
154, Številka:
5
Journal Article
Objective The present study evaluated the evolving trends and outcomes of patients undergoing isolated reoperative coronary artery bypass grafting at Society of Thoracic Surgeons Adult Cardiac ...Surgery Database–participating institutions. Methods From 2000 to 2009, 72,431 patients underwent isolated reoperative coronary artery bypass grafting and 1,497,254 patients underwent isolated primary coronary artery bypass grafting at Society of Thoracic Surgeons–participating institutions. The demographics, operative characteristics, and risk-adjusted postoperative outcomes were assessed and compared during the study period. Results As a percentage of overall coronary artery bypass grafting volume, reoperative coronary artery bypass grafting decreased from 6.0% (8820/137,267) in 2000 to 3.4% (5734/160,997) in 2009. The unadjusted operative mortality declined from 6.1% (542/8820) in 2000 to 4.6% (261/5734) in 2009 ( P < .05). Patients now more frequently present with left main disease (35.1% vs 25.7%; P < .05), myocardial infarction (60.9% vs 55.9%; P < .001), and heart failure (18.4% vs 14.2%; P < .001). Patients also now present more frequently for urgent or emergent surgery (51.6% vs 39%; P < .001) and after previous percutaneous coronary intervention (51% vs 35%; P < .001). They also have a greater incidence of other comorbidities such as increased weight (88 vs 84 kg; P < .001), diabetes (42.5% vs 31.7%; P < .001), hypertension (90.9% vs 73.4%; P < .001), hypercholesterolemia (90.9% vs 73.4%; P < .001), renal failure (2.2% vs 0.7%; P < .001), and cerebrovascular disease (12.4% vs 8.5%; P < .001). Risk-adjusted mortality decreased from 6.0% to 4.6%, a relative risk reduction of 23.7% ( P < .001). Risk-adjusted postoperative stroke decreased from 1.9% to 1.6% ( P < .001). Conclusions Surgical coronary revascularization has evolved during the past decade, with reoperative coronary artery bypass grafting now uncommonly performed in contemporary practice. Despite treating patients with more complex coronary artery disease and greater medical comorbidities, significant improvements have occurred in operative morbidity and mortality in this challenging population.
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