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The aim of this study was to develop a multivariate risk prediction model for prolonged ventilation after adult cardiac surgery.This is a retrospective analysis of prospectively collected data on 12,662 consecutive patients undergoing adult cardiac surgery between April 1997 and March 2005. Data were randomly split into a development dataset (n = 6,000) and a validation dataset (n = 6,662). A multivariate logistic regression analysis was undertaken using a forward stepwise technique to identify independent risk factors for prolonged ventilation (defined as ventilation greater than 48 hours). The area under the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow goodness-of-fit statistic were calculated to assess the performance and calibration of the model, respectively. Patients were split into low-, medium-, and high-risk groups based on their predicted probability of prolonged ventilation.Three hundred thirty-three patients had prolonged ventilation (5.5%). Independent variables, identified with prolonged ventilation, are shown with relevant coefficient values and p values as follows: (1) age 65 to 75 years, 0.7831, p0.001; (2) age 75 to 80 years, 1.5605, p0.001; (3) age greater than 80 years, 1.7115, p0.001; (4) forced expiratory volume less than 70% predicted, 0.3707, p = 0.013; (5) current smoker, 0.5315, p = 0.001; (6) serum creatinine 125 to 175 micromol/L, 0.6371, p0.001; (7) serum creatinine greater than 175 micromol/L, 1.3817, p0.001; (8) peripheral vascular disease, 0.6212, p0.001; (9) ejection fraction less than 0.30, 0.7839, p0.001; (10) myocardial infraction less than 90 days, 0.7415, p0.001; (11) preoperative ventilation, 1.3540, p = 0.004; (12) prior cardiac surgery, 0.8946, p0.001; (13) urgent surgery, 0.4414, p = 0.004; (14) emergency surgery, 0.7421, p = 0.005; (15) mitral valve surgery, 0.7715, p0.001; (16) aortic surgery, 1.7043, p0.001; and (17) use of cardiopulmonary bypass, 0.4052, p = 0.025; intercept, -4.7666. The ROC curve for the predicted probability of prolonged ventilation was 0.79, indicating a good discrimination power. The prediction equation was well-calibrated, predicting well at all levels of risk. A simplified additive scoring system was also developed. In the validation dataset, 5.1% of patients had prolonged ventilation compared with 5.4% expected. The ROC curve for the validation dataset was 0.75.We developed a contemporaneous multivariate prediction model for prolonged ventilation after cardiac surgery. This tool can be used in day-to-day practice to calculate patient-specific risk by the logistic equation or a simple scoring system with an equivalent predicted risk.

Background Elevated preprocedural systemic markers of inflammation, including white blood cell count, have been associated with adverse clinical outcomes after percutaneous coronary intervention. The relationship between preoperative white blood cell count and clinical outcomes after coronary artery bypass grafting is less clear despite increasing evidence that neutrophils participate in reperfusion injury. We sought to determine the relationship between preoperative white blood cell count and in hospital major morbidity and 1-year survival after coronary artery bypass grafting. Methods We prospectively studied 3,024 consecutive isolated coronary artery bypass graft procedures. Preoperative white blood cell count was determined by automated counter, perioperative cardiac enzyme release by the creatine kinase–myocardial band isoenzyme, and all-cause mortality over the first postoperative year taken from a national death registry. Multivariate logistic regression and Cox proportional hazards analyses were performed. Results Preoperative white blood cell count offered as a continuous variable and as five predetermined groups was independently associated with cardiac enzyme release three or more times the upper limit of the reference range (adjusted odds ratio=1.5 per 10 × 10 9 /L increase, 95% confidence interval: 1.2 to 2.0, p = 0.002) and higher 1-year mortality (adjusted hazard ratio=1.6 per 10 × 10 9 /L increase, 95% confidence interval: 1.2 to 2.1, p Conclusions Higher preoperative white blood cell count is independently associated with higher perioperative myonecrosis and 1-year mortality after coronary artery bypass grafting.

We report the case of a 12-year-old boy with a hypoplastic retroesophageal circumflex right-sided cervical aortic arch and coarctation. After the incidental finding of a heart murmur when the boy was 9 years old, cardiac magnetic resonance showed a right-sided cervical aortic arch, hypoplastic transverse arch, and separate origin of the left common carotid, right common carotid, right vertebral, and right subclavian arteries. The left subclavian artery arose from the proximal descending aorta next to the coarctation. An extra-anatomical ascending to descending aorta tube graft was inserted through a right lateral thoracotomy with good results.

We report the case of a 47-year-old man who presented with several episodes of left precordial pain, one of which had been severe, but was unrelated to exertion or posture. Transthoracic echocardiography and cardiovascular magnetic resonance showed evidence of congenital partial absence of the left pericardium and severe tricuspid regurgitation. Both diagnoses were confirmed at surgery when the pericardial defect was repaired and the tricuspid valve was replaced at the same operation. He went on to make a good recovery.

Acquired coronary artery to left atrial fistulas are rare and previously only described in mitral stenosis associated with left atrial thrombus or coronary arteriosclerosis. We present the case of a patient who developed a left circumflex coronary artery to left atrial fistula associated with mitral regurgitation 12 years after excision of a left atrial myxoma. This was successfully ligated at the time of mitral valve replacement.

We report a 31-year old woman who presented with acute onset of shortness of breath 19 years after multiple repairs of a preductal coarctation of the aorta using a Dacron tube graft. Imaging studies showed an aneurysm had developed in the tube graft. The aneurysmal tube graft was replaced during an open repair.