Volume 25, Issue 11 (2-2019)                   RJMS 2019, 25(11): 23-33 | Back to browse issues page

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Askari B, Mehdizadeh H, koomasi S. Evaluation of determinants of mortality in patients undergoing coronary artery bypass graft surgery in Urmia Seyed-al-Shohada Heart Center . RJMS 2019; 25 (11) :23-33
URL: http://rjms.iums.ac.ir/article-1-5337-en.html
Urmia University of Medical Sciences, Urmia, Iran , askaribehnam@ymail.com
Abstract:   (8422 Views)
Background: Cardiovascular diseases are the leading cause of mortality in Iran and in the world. There is a controversy about risk factors and causes of mortality following Coronary Artery Bypass Graft (CABG) surgery and the purpose of this study is to determine these factors.
Methods: In the retrospective case-control study, from March 2010 to July 2016 preoperative and intraoperative clinical data's of CABG patients were obtained and analyzed. Case group included 36 patients who died during the 30 days after operation and control group included 144 patients who had not died after surgery.
Results: The mortality rate during this interval was 1.29% (36/2774). Old age, female sex, three vessel disease, chronic obstructive pulmonary disease, left main involvement, mitral valve regurgitation, emergency surgery, preoperative critical condition, low hemoglobin level, high white blood cell count, peripheral vascular disease, high aortic cross clamping time, pulmonary hypertension, high cardiopulmonary bypass time, intra-aortic balloon pump placement and use of inotrope and pacemaker had a significant relationship with mortality.
Conclusion: Emergency surgery has a high mortality in the patients with preoperative critically ill conditions, especially in older women with multiple comorbidities. Preoperative precise assessment and correcting factors such as anemia, controlling inflammatory and pulmonary diseases, and reducing the duration of surgery is recommended to reduce mortality after surgery.
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Type of Study: Research | Subject: Cardio Muscular Disease

1. 1. World Health Organization. Global atlas on cardiovascular disease prevention and control. Geneva: World Health Organization; 2011.
2. 2. Ostovan MA, Darvish N, Askarian M. The prevalence of risk factors of coronary artery disease in the patients who underwent coronary artery bypass graft, Shiraz, Iran: suggesting a model. Int Cardiovasc Res J; 2014. 8(4):139.
3. 3. Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol; 2006. 47(10):2130-9.
4. 4. Rigi F, Bazdar P, Salehi Ardabili S, Naseri M, Feizi A. The effect of foot reflexology on anxiety in patients with coronary artery bypass surgery referred to Seyed-Al-Shohada teaching hospital, Urmia, 2012. The J Urmia Nurs Midwif Fac; 2013. 11(8):578-83.
5. 5. Winters WL. Houston hearts: A History of Cardiovascular Surgery and Medicine and The Methodist DeBakey Heart & Vascular Center. MDCVJ; 2015. XI (3s).
6. 6. Abdallah MS, Wang K, Magnuson EA, Osnabrugge RL Kappetein AP, Morice MC, et al. Quality of life after surgery or DES in patients with 3-vessel or left main disease. JACC; 2017. 16:69.
7. 7. Merkouris A, Apostolakis E, Pistolas D, Papagiannaki V, Diakomopoulou E, Patiraki E. Quality of life after coronary artery bypass graft surgery in the elderly. Eur J Cardiovasc Nurs; 2009. 8:74-81.
8. 8. Gallagher R, McKinley S. Stressors and anxiety in patients undergoing coronary artery bypass surgery. Am J Crit Care; 2007. 16(3):248-57.
9. 9. Imanipour M, Baasmpour S, Bahranii N.
10. Preoperative variables associated with extubation time in patients undergoing coronary artery bypass graft surgery. Hayat; 2006. 12(1):5-16.
11. 10. D’Agostino RS, Jacobs JP, Badhwar V, Paone G, Rankin JS, Han JM, et al. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Outcomes and Quality. Ann Thorac Surg; 2016. 101:24-32.
12. 11. Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. Risk of assessing mortality risk in elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony. Circulation; 2009. 119(24):3053-61.
13. 12. Ribeiro ALP, Gagliardi SPL, Nogueira JLS, Silveira LM, Colosimo EA, do Nascimento CAL. Mortality related to cardiac surgery in Brazil, 2000-2003. J Thorac Cardiovasc Surg; 2006. 131(4):907-9.
14. 13. Dos-Santos CA, De-Oliveira MAB, Brandi AC, Botelho PHH, Brandi JDM, Dos-Santos MA, et al. Risk factors for mortality of patients undergoing coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc; 2014. 29(4):513-20.
15. 14. Hannan EL, Wu C, Ryan TJ, Bennett E, Culliford AT, Gold JP, et al. Do hospitals and surgeons with higher coronary artery bypass graft surgery volumes still have lower risk-adjusted mortality rates? Circulation; 2003. 108(7):795-801.
16. 15. Movahed MR, Ramaraj R, Khoynezhad A, Hashemzadeh M, Hashemzadeh M. Declining in-hospital mortality in patients undergoing coronary bypass surgery in the United States irrespective of presence of type2 diabetes or congestive heart failure. Clin Cardiol; 2012. 35(5):297-300.
17. 16. Swaminathan RV, Feldman DN, Pashun RA, Patil RK, Shah T, Geleris JD, et al. Gender differences in in-hospital outcomes after coronary artery bypass grafting. Am J Cardiol; 2016. 118(3):362-8.
18. 17. Blankstein R, Ward RP, Arnsdorf M, Jones B, Lou YB, Pine M. Female genderis an independent predictor of operative mortality after coronary artery bypass graft surgery contemporary analysis of 31 midwestern hospitals. Circulation; 2005. 112:323-7.
19. 18. Terada T, Johnson JA, Norris C, Padwal R, Qiu W, Sharma AM, et al. Severe obesity Is associated with increased risk of early complications and extended length of stay following coronary artery bypass grafting surgery. J Am Heart Assoc; 2016. 5(6).
20. 19. Tsuneyoshi H, Komiya T, Shimamoto T, Sakai J, Hiraoka T, Wada K, et al. Risk factors for poor prognosis of coronary artery bypass grafting in the patients with diabetes. J Jpn Coron Assoc; 2016. 22:251-7.
21. 20. Manganas H, Lacasse Y, Bourgeois S, Perron J, Dagenais F, Maltais F. Postoperative outcome after coronary artery bypass grafting in chronic obstructive pulmonary disease. Can Respir J; 2007. 14(1):19-24.
22. 21. Saleh HZ, Mohan K, Shaw M, Al-Rawi O, Elsayed H, Walshaw M, et al. Impact of chronic obstructive pulmonary disease severity on surgical outcomes in patients undergoing non-emergent coronary artery bypass grafting. Eur J Cardiothorac Surg; 2012. 42:108-13.
23. 22. Van Straten AH, Firanescu C, Hamad MA, Tan MES, Woorst JFJ, Martens EJ, et al. Peripheral vascular disease as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population. Ann Thorac Surg; 2010. 89:414-20.
24. 23. Kolh PH, Comte L, Tchana-Sato V, Honore C, Kerzmann A, Mauer M, et al. Concurrent coronary and carotid artery surgery: factors influencing perioperative outcome and long-term results. Eur Heart J; 2006. 27:49-56.
25. 24. Van Straten AH, Hamad MA, Van Zundert AJ,Martens EJ, Schönberger JP, De Wolf AM, et al. Preoperative hemoglobin level as a predictor of survival after coronary artery bypass grafting: a comparison with the matched general population. Circulation; 2009. 120:118.
26. 25. Brown JR, Landis RC, Chaisson K, Ross CS, Dacey LJ, Boss Jr RA, et al. Preoperative White Blood Cell Count and Risk of 30-Day Readmission after Cardiac Surgery. Int J Inflam; 2013:7.
27. 26. Lopez NH, Paulistsch FD, Gois AF, Pereira AC, Stolf NA, Dallan LO, et al. Impact of number of vessels disease on outcome of patients with stable coronary artery disease: 5-year follow-up of the medical angioplasty, and bypass surgery study (MASS). Eur J Cardiothorac Surg; 2008. 33:349-54.
28. 27. Jonsson A, Hammar N, Nordquist T, Ivert T. Left main coronary artery stenosis no longer a risk factor for early and late death after coronary artery bypass surgery — an experience covering three decades. Eur J Cardiothorac Surg; 2006. 30:311-7.
29. 28. Gol MK, Ozsoyler I, Sener E, Goksel S, SaritaS A, Tagdemir O, et al. Is Left Main Coronary Artery Stenosis a Risk Factor for Early Mortality in Coronary Artery Surgery? J Card Surg; 2000. 15:217-22.
30. 29. Topkara VK, Cheema FH, Kesavaramanujam S, Mercando ML, Cheema AF, Namerow PB, et al. Coronary artery bypass grafting in patients with low ejection fraction. Circulation; 2005. 112:344-50.
31. 30. Michler RE, Smith PK, Parides MK, Ailawadi G, Thourani V, Moskowitz AJ, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med; 2016. 374:1932-41.
32. 31. Penicka M, Linkova H, Lang O, Fojt R, Kocka V, Vanderheyden M, et al. Predictors of Improvement of Unrepaired Moderate Ischemic Mitral Regurgitation in Patients Undergoing Elective Isolated Coronary Artery Bypass Graft Surgery. Circulation; 2009. 120:1474-81.
33. 32. Denault A, Deschamps A, Tardif JC, Lambert J, Perrault L. Pulmonary hypertension in cardiac surgery. Curr Cardiol Rev; 2010. 6:1-14.
34. 33. Kennedy JLW, LaPar DJ, Kern JA, Kron IL, Bergin JD, Kamath S, et al. Does the ociety of Thoracic Surgeons risk score accurately predict operative mortality for patients with pulmonary hypertension? J Thorac Cardiovasc Surg; 2013. 146:631-7.
35. 34. Schumer EM, Chaney JH, Trivedi JR, Linsky PL, Williams ML, Slaughter MS. Emergency coronary artery bypass grafting: indications and outcomes from 2003 through 2013. Tex Heart Inst J; 2016. 43(3):214-9.
36. 35. Axelsson TA, Mennander A, Malmberg M, Jarmo Gunn J, Jeppsson A, Gudbjartsson T. Is emergency and salvage coronary artery bypass grafting justified? The Nordic Emergency/Salvage coronary artery bypass graftings study. Eur J Cardiothorac Surg; 2016. 49:1451-6.
37. 36. Kim DK, Yoo KJ, Hong YS, Chang BC, Kang MS. Clinical outcome of urgent coronary artery bypass grafting. J Korean Med Sci; 2007. 22:270-6.
38. 37. Sarraf N, Thalib L, Hughes A, Houlihan M, Tolan M, Young V, et al. Cross-clamp time is an independent predictor of mortality and morbidity in low and high risk patints. Int J Surg; 2011. 9:104-9.
39. 38. Miller M, Junger A, Brau M, Kwapisz MM, Schindler E, Akintiirk H, et al. Incidence and risk calculation of inotropic support in patients undergoing cardiac surgery with cardiopulmonary bypass using an automated anaesthesia record-keeping system. Br J Anaesth; 2002. 89(3):398-404.
40. 39. Williams JB, Hernandez AF, Li SH, Dokholyan RS, O'Brien SM, Smith PK, et al. Postoperative inotrope and vasopressor use following CABG: Outcome data from the CAPS-care study. J Card Surg; 2011. 26(6):572-8.
41. 40. Miceli A, Fiorani B, Danesi TH, Melina G, Sinatra R. Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass grafting: a propensity score analysis.
42. Interact Cardiovasc Thorac Surg; 2009. 291-5.
43. 41. Wan YD, Sun TW, Kan QC, Guan FX, Liu ZQ, Zhang SG. The effects of intra-aortic balloon pumps on mortality in patients undergoing high-risk coronary revascularization: A meta-analysis of randomized controlled trials of coronary artery bypass grafting and stenting era. PLoS One; 2016. 11(1):1-13.

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