Antonino S Rubino1, Francesco Nicolini2, Tuomas Tauriainen3, Till Demal4, Marisa De Feo1, Francesco Onorati5, Giuseppe Faggian5, Ciro Bancone1, Andrea Perrotti6, Sidney Chocron6, Magnus Dalén7,8, Giuseppe Santarpino9,10, Theodor Fischlein9, Daniele Maselli11, Francesco Musumeci12, Francesco Santini13, Antonio Salsano13, Marco Zanobini14, Matteo Saccocci14, Karl Bounader15, Giuseppe Gatti16, Vito G Ruggieri17, Carmelo Mignosa18, Tatu Juvonen3,19, Giovanni Mariscalco20, Fausto Biancari3,19,21. 1. Division of Cardiac Surgery, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy. 2. Division of Cardiac Surgery, University of Parma, Parma, Italy. 3. Department of Surgery, Oulu University Hospital and Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland. 4. Hamburg University Heart Center, Hamburg, Germany. 5. Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy. 6. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. 7. Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 8. Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 9. Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany. 10. Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy. 11. Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy. 12. Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy. 13. Division of Cardiac Surgery, University of Genoa, Genoa, Italy. 14. Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy. 15. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. 16. Cardio-Thoracic and Vascular Department, Trieste University Hospital, Trieste, Italy. 17. Division of Thoracic and Cardiovascular Surgery, Robert Debré University Hospital, Reims, France. 18. Cardiothoracic Department, ISMeTT/UPMC, Palermo, Italy. 19. Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. 20. Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK. 21. Department of Surgery, University of Turku, Turku, Finland.
Abstract
OBJECTIVES: This study aims to investigate the incidence and determinants of major early adverse events in low-risk patients undergoing isolated coronary artery bypass grafting (CABG). METHODS: The multicentre E-CABG registry included 7352 consecutive patients who underwent isolated CABG from January 2015 to December 2016. Patients with an European System for Cardiac Operative Risk Evaluation (EuroSCORE) II of <2% and without any major comorbidity were the subjects of the present analysis. RESULTS: Out of 2397 low-risk patients, 11 (0.46%) died during the index hospitalization or within 30 days from surgery. Five deaths were cardiac related, 4 of which were secondary to technical failures. We estimated that 8 out of 11 deaths were potentially preventable. Logistic regression model identified porcelain aorta [odds ratio (OR) 34.3, 95% confidence interval (CI) 1.3-346.3] and E-CABG bleeding grades 2-3 (OR 30.2, 95% CI 8.3-112.9) as independent predictors of hospital death. CONCLUSIONS: Mortality and major complications, although infrequently, do occur even in low-risk patients undergoing CABG. Identification of modifiable causes of postoperative adverse events may be useful to develop preventative strategies to improve the quality of care of patients undergoing cardiac surgery. CLINICAL TRIAL REGISTRATION: NCT02319083 (https://clinicaltrials.gov/ct2/show/NCT02319083).
OBJECTIVES: This study aims to investigate the incidence and determinants of major early adverse events in low-risk patients undergoing isolated coronary artery bypass grafting (CABG). METHODS: The multicentre E-CABG registry included 7352 consecutive patients who underwent isolated CABG from January 2015 to December 2016. Patients with an European System for Cardiac Operative Risk Evaluation (EuroSCORE) II of <2% and without any major comorbidity were the subjects of the present analysis. RESULTS: Out of 2397 low-risk patients, 11 (0.46%) died during the index hospitalization or within 30 days from surgery. Five deaths were cardiac related, 4 of which were secondary to technical failures. We estimated that 8 out of 11 deaths were potentially preventable. Logistic regression model identified porcelain aorta [odds ratio (OR) 34.3, 95% confidence interval (CI) 1.3-346.3] and E-CABG bleeding grades 2-3 (OR 30.2, 95% CI 8.3-112.9) as independent predictors of hospital death. CONCLUSIONS:Mortality and major complications, although infrequently, do occur even in low-risk patients undergoing CABG. Identification of modifiable causes of postoperative adverse events may be useful to develop preventative strategies to improve the quality of care of patients undergoing cardiac surgery. CLINICAL TRIAL REGISTRATION: NCT02319083 (https://clinicaltrials.gov/ct2/show/NCT02319083).