PMID- 30248795
OWN - NLM
STAT- MEDLINE
DCOM- 20190925
LR  - 20190925
IS  - 1097-685X (Electronic)
IS  - 0022-5223 (Linking)
VI  - 156
IP  - 4
DP  - 2018 Oct
TI  - Risk of conventional cardiac surgery among patients with severe left ventricular 
      dysfunction in the era of mechanical circulatory support.
PG  - 1530-1540.e2
LID - S0022-5223(18)31546-0 [pii]
LID - 10.1016/j.jtcvs.2018.04.130 [doi]
AB  - BACKGROUND: Despite suggestions that severe left ventricle dysfunction may 
      warrant selection of durable mechanical circulatory support over conventional 
      surgery, comparative studies are lacking due to incomplete characterization of 
      patients at highest risk after conventional surgery. We sought to define subsets 
      of patients with severe left ventricle dysfunction who are at greatest mortality 
      risk following conventional cardiac surgery. METHODS: We studied 892 patients 
      aged >/= 18 years who underwent conventional coronary or valve surgery from 1993 to 
      2014, with preoperative ejection fraction </= 25%. Exclusions were transcatheter 
      interventions, major concomitant procedures, active endocarditis, and 
      prior/concurrent durable mechanical circulatory support use. Logistic and Cox 
      regression identified determinants of early and late mortality. RESULTS: Median 
      age was 70 years (interquartile range, 62-76 years), 46% (n = 411) had New York 
      Heart Association (NYHA) functional class IV symptoms, and 16% (n = 142) had 
      undergone prior surgery. Operative mortality was 7.5%. NYHA functional class IV 
      (odds ratio [OR], 1.88; P = .033), prior cardiac surgery (OR, 2.13; P = .017), 
      peripheral vascular disease (OR, 2.55; P = .001), emergency status (OR, 2.68; 
      P = .024), and intra-aortic balloon pump use (OR, 4.95; P < .001) independently 
      predicted operative death. Risk imparted by presence of both NYHA functional 
      class IV symptoms and prior surgery was additive, with a 4-fold increase in early 
      mortality risk (OR, 3.95; P = .003). Prior surgery increased the hazard of late 
      death by 60% (P < .001). In patients without prior surgery, late mortality was 
      greatest in those aged >/= 70 years (hazard ratio, 1.86; P < .001), especially if 
      NYHA functional class IV symptoms were concurrently present (hazard ratio, 2.25; 
      P < .001). Surgery type (coronary artery bypass graft surgery, aortic valve 
      surgery, or mitral valve surgery) did not predict long-term outcome. CONCLUSIONS: 
      In patients referred for conventional surgery with an ejection fraction </= 25%, 
      prior cardiac surgery, and/or NYHA functional class IV symptoms-particularly in 
      those aged >/= 70 years-confer significant and sustained survival disadvantages. 
      Such high-risk subsets may benefit from durable mechanical circulatory support 
      consideration.
CI  - Copyright (c) 2018 The American Association for Thoracic Surgery. Published by 
      Elsevier Inc. All rights reserved.
FAU - Thalji, Nassir M
AU  - Thalji NM
AD  - Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, 
      Minn.
FAU - Maltais, Simon
AU  - Maltais S
AD  - Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, 
      Minn.
FAU - Daly, Richard C
AU  - Daly RC
AD  - Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, 
      Minn.
FAU - Greason, Kevin L
AU  - Greason KL
AD  - Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, 
      Minn.
FAU - Schaff, Hartzell V
AU  - Schaff HV
AD  - Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, 
      Minn.
FAU - Dunlay, Shannon M
AU  - Dunlay SM
AD  - Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 
      Rochester, Minn.
FAU - Stulak, John M
AU  - Stulak JM
AD  - Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, 
      Minn. Electronic address: stulak.john@mayo.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20180618
PL  - United States
TA  - J Thorac Cardiovasc Surg
JT  - The Journal of thoracic and cardiovascular surgery
JID - 0376343
SB  - IM
CIN - J Thorac Cardiovasc Surg. 2018 Oct;156(4):1527. PMID: 29934008
CIN - J Thorac Cardiovasc Surg. 2018 Oct;156(4):1541-1542. PMID: 30017446
MH  - Aged
MH  - Cardiac Surgical Procedures/*adverse effects/mortality
MH  - *Extracorporeal Membrane Oxygenation/mortality
MH  - Female
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Risk Factors
MH  - Stroke Volume
MH  - Survival Analysis
MH  - Ventricular Dysfunction, Left/mortality/*surgery
OTO - NOTNLM
OT  - coronary artery bypass
OT  - heart failure
OT  - valve surgery
OT  - ventricular dysfunction
EDAT- 2018/09/27 06:00
MHDA- 2019/09/26 06:00
CRDT- 2018/09/26 06:00
PHST- 2017/04/30 00:00 [received]
PHST- 2018/02/25 00:00 [revised]
PHST- 2018/04/11 00:00 [accepted]
PHST- 2018/09/26 06:00 [entrez]
PHST- 2018/09/27 06:00 [pubmed]
PHST- 2019/09/26 06:00 [medline]
AID - S0022-5223(18)31546-0 [pii]
AID - 10.1016/j.jtcvs.2018.04.130 [doi]
PST - ppublish
SO  - J Thorac Cardiovasc Surg. 2018 Oct;156(4):1530-1540.e2. doi: 
      10.1016/j.jtcvs.2018.04.130. Epub 2018 Jun 18.