BACKGROUND: This study evaluated our institutional experience in forming a surgeon-based committee to discuss and provide consensus opinion on high-risk cardiac surgical cases. METHODS: The committee consisted of 4 surgeons with at least 1 senior surgeon at any given time with a rotating schedule. Patients with a Society of Thoracic Surgeons predicted risk of mortality above specified thresholds were mandated for referral to the committee in addition to patients referred at the discretion of the surgeon. Kaplan-Meier analysis was used to model survival. RESULTS: A total of 110 consecutive patients were reviewed by the committee. The most common procedure types for referral were isolated coronary artery bypass grafting (47.3%; n = 52) and coronary artery bypass grafting with concomitant aortic valve replacement (19.1%; n = 21). The overall median Society of Thoracic Surgeons predicted risk of mortality for referred patients was 5.35% (interquartile range, 4.07%-7.89%). After group discussion, a total of 62 patients were recommended to proceed with surgery (56.4%). Reasons for declining surgery included consensus that an intervention was not indicated (39.6%; n = 19), that an alternative, nonsurgical procedure was recommended (29.2%; n = 14), that there was continued medical management and reevaluation (18.8%; n = 9), and that the patient was deemed at too high a risk for surgery (12.5%; n = 6). Operative mortality in patients proceeding with surgery was 4.6% (n = 2), with an observed-to-expected mortality of 0.86. The 6-month survival after surgery was 92.2%. CONCLUSIONS: Implementation of a surgeon-based committee to discuss high-risk cases provided a unified voice to referring physicians and facilitated consensus decision-making with acceptable clinical outcomes in a challenging patient cohort.
BACKGROUND: This study evaluated our institutional experience in forming a surgeon-based committee to discuss and provide consensus opinion on high-risk cardiac surgical cases. METHODS: The committee consisted of 4 surgeons with at least 1 senior surgeon at any given time with a rotating schedule. Patients with a Society of Thoracic Surgeons predicted risk of mortality above specified thresholds were mandated for referral to the committee in addition to patients referred at the discretion of the surgeon. Kaplan-Meier analysis was used to model survival. RESULTS: A total of 110 consecutive patients were reviewed by the committee. The most common procedure types for referral were isolated coronary artery bypass grafting (47.3%; n = 52) and coronary artery bypass grafting with concomitant aortic valve replacement (19.1%; n = 21). The overall median Society of Thoracic Surgeons predicted risk of mortality for referred patients was 5.35% (interquartile range, 4.07%-7.89%). After group discussion, a total of 62 patients were recommended to proceed with surgery (56.4%). Reasons for declining surgery included consensus that an intervention was not indicated (39.6%; n = 19), that an alternative, nonsurgical procedure was recommended (29.2%; n = 14), that there was continued medical management and reevaluation (18.8%; n = 9), and that the patient was deemed at too high a risk for surgery (12.5%; n = 6). Operative mortality in patients proceeding with surgery was 4.6% (n = 2), with an observed-to-expected mortality of 0.86. The 6-month survival after surgery was 92.2%. CONCLUSIONS: Implementation of a surgeon-based committee to discuss high-risk cases provided a unified voice to referring physicians and facilitated consensus decision-making with acceptable clinical outcomes in a challenging patient cohort.
Authors: Rick A Nishimura; Catherine M Otto; Robert O Bonow; Blase A Carabello; John P Erwin; Lee A Fleisher; Hani Jneid; Michael J Mack; Christopher J McLeod; Patrick T O'Gara; Vera H Rigolin; Thoralf M Sundt; Annemarie Thompson Journal: J Am Coll Cardiol Date: 2017-03-15 Impact factor: 24.094
Authors: Helmut Baumgartner; Volkmar Falk; Jeroen J Bax; Michele De Bonis; Christian Hamm; Per Johan Holm; Bernard Iung; Patrizio Lancellotti; Emmanuel Lansac; Daniel Rodriguez Muñoz; Raphael Rosenhek; Johan Sjögren; Pilar Tornos Mas; Alec Vahanian; Thomas Walther; Olaf Wendler; Stephan Windecker; Jose Luis Zamorano Journal: Eur Heart J Date: 2017-09-21 Impact factor: 29.983
Authors: Sean M O'Brien; Liqi Feng; Xia He; Ying Xian; Jeffrey P Jacobs; Vinay Badhwar; Paul A Kurlansky; Anthony P Furnary; Joseph C Cleveland; Kevin W Lobdell; Christina Vassileva; Moritz C Wyler von Ballmoos; Vinod H Thourani; J Scott Rankin; James R Edgerton; Richard S D'Agostino; Nimesh D Desai; Fred H Edwards; David M Shahian Journal: Ann Thorac Surg Date: 2018-03-22 Impact factor: 4.330
Authors: Jonathan Afilalo; Sandra Lauck; Dae H Kim; Thierry Lefèvre; Nicolo Piazza; Kevin Lachapelle; Giuseppe Martucci; Andre Lamy; Marino Labinaz; Mark D Peterson; Rakesh C Arora; Nicolas Noiseux; Andrew Rassi; Igor F Palacios; Philippe Généreux; Brian R Lindman; Anita W Asgar; Caroline A Kim; Amanda Trnkus; José A Morais; Yves Langlois; Lawrence G Rudski; Jean-Francois Morin; Jeffrey J Popma; John G Webb; Louis P Perrault Journal: J Am Coll Cardiol Date: 2017-07-07 Impact factor: 24.094
Authors: Bryan M Burt; Andrew W ElBardissi; Robert S Huckman; Lawrence H Cohn; Marisa W Cevasco; James D Rawn; Sary F Aranki; John G Byrne Journal: J Thorac Cardiovasc Surg Date: 2015-08-01 Impact factor: 5.209