George J Arnaoutakis1, Arman Kilic2, John V Conte3, Sunghee Kim4, J Matthew Brennan5, Brian C Gulack5, Fred H Edwards6, Jeffrey P Jacobs7, Ibrahim Sultan8. 1. Division of Cardiac Surgery, University of Florida, Gainesville, Florida. 2. Division of Cardiac Surgery and Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania. 3. Division of Cardiac Surgery, Penn State University, Hershey, Pennsylvania. 4. Outcomes Research and Assessment Group, Duke Clinical Research Institute, Chapel Hill, North Carolina. 5. Department of Surgery, Duke University School of Medicine, Chapel Hill, North Carolina. 6. Shands Jacksonville, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida. 7. Division of Cardiac Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, Florida. 8. Division of Cardiac Surgery and Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: sultani@upmc.edu.
Abstract
BACKGROUND: Patients undergoing post infarction ventricular septal defect repair are at high risk for early morbidity and mortality, but little is known about subsequent clinical events. This study uses short-term clinical data from The Society of Thoracic Surgeons National Database linked with Medicare data to examine longer term outcomes in these patients. METHODS: This was a retrospective review of The Society of Thoracic Surgeons National Database to link with Medicare data all adults (≥65 years) who underwent ventricular septal defect repair after a myocardial infarction between 2008 and 2012. The primary outcome was 1-year mortality. Risk factors for 1-year survival were modeled using a multivariable Cox regression. RESULTS: Five hundred thirty-seven patients were identified using The Society of Thoracic Surgeons database and Medicare linkage. Median age was 74 years, and 277 patients (52%) were men. One hundred ninety-two patients (36%) were supported preoperatively with an intraaortic balloon pump. Surgical status was emergent or salvage in 138 (26%), and 158 patients (29%) died within 30 days and 207 (39%) within 1 year. Among patients who survived to hospital discharge, 44% were discharged to a facility and 172 (32%) experienced at least 1 all-cause readmission within 1 year. Unadjusted 1-year mortality rates were 13% for elective patients and 69% for emergency status (P < .01). On multivariable analysis emergency/salvage status, older age, and concomitant coronary artery bypass grafting were independently associated with worse 1-year survival. CONCLUSIONS: These data suggest the greatest mortality risk in this patient population occurs in the first 30 days. Emergency or salvage status strongly predicts 1-year mortality. Optimizing physiologic derangements before operative repair may be considered when possible in this subgroup of patients.
BACKGROUND:Patients undergoing post infarction ventricular septal defect repair are at high risk for early morbidity and mortality, but little is known about subsequent clinical events. This study uses short-term clinical data from The Society of Thoracic Surgeons National Database linked with Medicare data to examine longer term outcomes in these patients. METHODS: This was a retrospective review of The Society of Thoracic Surgeons National Database to link with Medicare data all adults (≥65 years) who underwent ventricular septal defect repair after a myocardial infarction between 2008 and 2012. The primary outcome was 1-year mortality. Risk factors for 1-year survival were modeled using a multivariable Cox regression. RESULTS: Five hundred thirty-seven patients were identified using The Society of Thoracic Surgeons database and Medicare linkage. Median age was 74 years, and 277 patients (52%) were men. One hundred ninety-two patients (36%) were supported preoperatively with an intraaortic balloon pump. Surgical status was emergent or salvage in 138 (26%), and 158 patients (29%) died within 30 days and 207 (39%) within 1 year. Among patients who survived to hospital discharge, 44% were discharged to a facility and 172 (32%) experienced at least 1 all-cause readmission within 1 year. Unadjusted 1-year mortality rates were 13% for elective patients and 69% for emergency status (P < .01). On multivariable analysis emergency/salvage status, older age, and concomitant coronary artery bypass grafting were independently associated with worse 1-year survival. CONCLUSIONS: These data suggest the greatest mortality risk in this patient population occurs in the first 30 days. Emergency or salvage status strongly predicts 1-year mortality. Optimizing physiologic derangements before operative repair may be considered when possible in this subgroup of patients.
Authors: Jahanzeb Malik; Faizan Younus; Asmara Malik; Muhammad Umar Farooq; Ahmed Kamal; Muhammad Shoaib; Hesham Naeem; Ghazanfar Rana; Abdul Sattar Rana; Muhammad Usman; Shahid Khalil Journal: PLoS One Date: 2021-08-18 Impact factor: 3.752
Authors: Abdulla A Damluji; Sean van Diepen; Jason N Katz; Venu Menon; Jacqueline E Tamis-Holland; Marie Bakitas; Mauricio G Cohen; Leora B Balsam; Joanna Chikwe Journal: Circulation Date: 2021-06-15 Impact factor: 39.918