Search

Background A change in cardiac surgery practice over the past decade has seen an increase in urgent or inpatient referrals for surgery, with antiplatelet therapy often continued up until surgery. This study aims to identify the optimal timing for administration of aspirin to minimise risk of perioperative morbidity and mortality. Methods From a prospectively compiled database collected by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, we identified 8294 patients undertaking combined CABG and valve or isolated valve procedures while discontinuing aspirin. Time points for cessation of antiplatelet therapy were categorised as follows: <2 days, 3–7 days or >7 days preoperatively. We evaluated the association of adverse in-hospital events and intermediate term survival in each time category. Results Discontinuing aspirin 3 to 7 days from surgery decreased rates of perioperative MI (HR = 0.300, p = 0.027), return to theatre (HR = 0.560, p = 0.002) reduced drain output (HR = 0.757, p = 0.000) and red blood cell and platelet transfusions (HR = 0.719, p = 0.000 and HR = 0.604, p = 0.000 respectively) compared to patients continuing aspirin until <2 days from the procedure. Stopping aspirin <2 days from the date of surgery increased risk of perioperative MI (HR = 5.919, p = 0.000), reoperation for bleeding (HR = 2.076, p = 0.001), returning to theatre (HR = 1.781, p = 0.000), ICC drain losses (HR = 1.337, p = 0.000) and transfusion demands for red blood cells (HR = 1.381, p = 0.000) and platelets (HR = 1.450, p = 0.000) when compared to those discontinuing aspirin >7 days from surgery. Conclusion Late discontinuation of aspirin before combined coronary artery bypass graft and valve procedures results in greater rates of bleeding and transfusion requirements. Earlier discontinuation of aspirin results in no benefit in intermediate term survival. [ABSTRACT FROM AUTHOR]

Background: To compare six risk scores with regard to their validity to predict in-hospital mortality after heart valve surgery in a single-centre patient population of China. Methods: From January 2006 to December 2011, 3479 consecutive patients who underwent heart valve surgery at our centre were collected and scored according to the EuroSCORE II, VA risk score, NNE risk score, Ambler risk score, NYC risk score, and STS risk score. Calibration of the six risk scores was assessed by the Hosmer–Lemeshow (H–L) test. Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. Results: Observed mortality was 3.32% overall. The STS score showed good calibration in predicting in-hospital mortality (H–L: P =0.126). The EuroSCORE II, VA score, NNE score, and NYC score underpredicted observed mortality (H–L: P <0.0001, P <0.0001, P =0.001, and P <0.0001, respectively) and the Ambler score overpredicted observed mortality (H–L: P =0.005). The discriminative power (i.e. the area under the ROC curve) for in-hospital mortality was highest for the STS score (0.706), followed by the EuroSCORE II model (0.693), NNE score (0.684), NYC score (0.682), Ambler score (0.677) and VA score (0.643). Conclusion: Compared with the EuroSCORE II, VA score, NNE score, NYC score, and the Ambler score, the STS score gives an accurate prediction for individual operative risk in patients undergoing heart valve surgery at our centre. Therefore, the use of the STS score for risk evaluation maybe suitable in patients undergoing heart valve surgery at our centre in the future. [Copyright &y& Elsevier]

Background: To assess the performance of the The European System for Cardiac Operative. Risk Evaluation II (EuroSCORE II) in Chinese patients undergoing heart valve surgery at our centre. Methods: From January 2006 to December 2011, 3479 consecutive patients who underwent heart valve surgery at our centre were collected and scored according to the original EuroSCORE and EuroSCORE II models. All patients were divided into single valve surgery and multiple valve surgery subgroups. The entire cohort and each subgroup were analysed. Calibration of the original EuroSCORE and EuroSCORE II models was assessed by the Hosmer–Lemeshow (H–L) test. Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. Results: Observed mortality was 3.32% overall, compared to expected mortality 3.84% for the original additive EuroSCORE (H–L: P =0.013), 3.33% for the original logistic EuroSCORE (H–L: P =0.08), and 2.52% for the EuroSCORE II (H–L: P <0.0001). The EuroSCORE II model showed good calibration in predicting in-hospital mortality for patients undergoing single valve surgery (H–L: P =0.103) and poor calibration for patients undergoing multiple valve surgery (H–L: P <0.0001). The discriminative power of the original EuroSCORE model (area under the ROC curve of 0.684 and 0.673 for the additive and logistic model, respectively) and EuroSCORE II model (area under the ROC curve of 0.685) for the entire cohort was poor. The discriminative power of the EuroSCORE II model was good for the single valve surgery group (area under the ROC curve of 0.792) and was poor for the multiple valve surgery group (area under the ROC curve of 0.605). Conclusion: The EuroSCORE II model gives an accurate prediction for individual operative risk in patients undergoing single valve surgery but an imprecise prediction in patients undergoing multiple valve surgery at our centre. Therefore, the use of the EuroSCORE II model for risk evaluation may be suitable in patients undergoing single valve surgery, and the creation of a new model which accurately predicts outcomes in patients undergoing multiple valve surgery is possibly required at our centre in the future. [Copyright &y& Elsevier]

Background: The aim of this study was to develop a preoperative risk prediction model and an scorecard for prolonged intensive care unit length of stay (PrlICULOS) in adult patients undergoing heart valve surgery. Methods: This is a retrospective observational study of collected data on 3925 consecutive patients older than 18 years, who had undergone heart valve surgery between January 2000 and December 2010. Data were randomly split into a development dataset (n =2401) and a validation dataset (n =1524). A multivariate logistic regression analysis was undertaken using the development dataset to identify independent risk factors for PrlICULOS. Performance of the model was then assessed by observed and expected rates of PrlICULOS on the development and validation dataset. Model calibration and discriminatory ability were analysed by the Hosmer–Lemeshow goodness-of-fit statistic and the area under the receiver operating characteristic (ROC) curve, respectively. Results: There were 491 patients that required PrlICULOS (12.5%). Preoperative independent predictors of PrlICULOS are shown with odds ratio as follows: (1) age, 1.4; (2) chronic obstructive pulmonary disease (COPD), 1.8; (3) atrial fibrillation, 1.4; (4) left bundle branch block, 2.7; (5) ejection fraction, 1.4; (6) left ventricle weight, 1.5; (7) New York Heart Association class III–IV, 1.8; (8) critical preoperative state, 2.0; (9) perivalvular leakage, 6.4; (10) tricuspid valve replacement, 3.8; (11) concurrent CABG, 2.8; and (12) concurrent other cardiac surgery, 1.8. The Hosmer–Lemeshow goodness-of-fit statistic was not statistically significant in both development and validation dataset (P =0.365 vs P =0.310). The ROC curve for the prediction of PrlICULOS in development and validation dataset was 0.717 and 0.700, respectively. Conclusion: We developed and validated a local risk prediction model for PrlICULOS after adult heart valve surgery. This model can be used to calculate patient-specific risk with an equivalent predicted risk at our centre in future clinical practice. [Copyright &y& Elsevier]

We present an eight year-old girl who required an operation for moderate mitral insufficiency associated with partial atrioventricular septal defect. Echocardiography disclosed an ostium primum atrial septal defect and double-orifice mitral valve with moderate mitral regurgitation secondary to a cleft in the anterior leaflet and prolapse of the anterior leaflet. Intraoperative inspection revealed that the chordae from each orifice were attached to a single papillary muscle which resulted in a unique double-orifice mitral valve. Mitral valve repair using chordal shortening and cleft closure was successfully performed. Postoperative echocardiography observed trivial MR and no mitral stenosis. [ABSTRACT FROM AUTHOR]