SATS 2009 Final Program - Scandinavian Association for Thoracic ...

P01:22
URGENT CABG PREDISPOSES PATIENTS TO REOPERATIONS- MAINLY DUE TO EXCESSIVE BLEEDING
Suojaranta-ylinen Raili 1 , Hiippala Seppo 1
1) Helsinki University Hospital, Finland
Treatment of acute coronary syndrome (ACS) demands aggressive anti-thrombotic therapy and occasionally
also mechanical circulatory support. Both may increase the risk of reoperation after urgent CABG surgery. This
retrospective study was focused on the causes of these reoperations.
Methods
The inclusion criteria were urgent or emergent CABG after admission for ACS and the use of cardiopulmonary
bypass. Combined operations including valves or other procedures and off-pump surgeries were excluded. 544
patients were found with an estimated 95.7 % coverage of the target population. All patient records were reviewed
to verify the cause of reoperation. The results were compared to a group of elective CABG patients. The odds ratios
with 95% confidence intervals were calculated for the relevant events.
Results
The groups were comparable regarding sex, age, perfusion time, number of distal anastomosis and ReDo operations.
The urgent group had significantly higher Euroscore, all patients were exposed to anti-thrombotic therapy and 12.5%
had perioperative intra-aortic balloon pump compared to just 1.1% in the elective group. In the urgent group the
odds were 2,83 (1,40-5,70) for a reoperation due to excessive bleeding and 4,11 (1,53-11,04) for all other causes
compared to the elective group. The proportion of reoperations for surgical bleeding was the same in both groups.
Conclusions
Urgent CABG increased the odds for reoperation three to four fold and in two cases out of three the indication was
excessive bleeding. In both groups the cause of bleeding was surgical in more than two reoperations out of three.
P01:23
OBESITY AND THE RATE OF EARLY COMPLICATIONS AFTER CORONARY ARTERIAL REVASCULARISATION
Oddsson Saemundur J. 1 , Sigurjonsson Hannes 1 , Arnorsson Thorarinn 1 , Gudbjartsson Tomas 1
1) Landspitali University Hospital, Iceland
Introduction
Traditionally obesity has been related to increased postoperative morbidity and mortality following open heart
surgery. Recent studies, however, indicate that the association of obesity and complications is not straight-forward,
with some studies even reporting a beneficial association (obesity paradox). The aim of this study was to study this
relationship in a well defined cohort of CABG/OPCAB patients.
Material and methods
A retrospective non-randomised study on all patients that underwent CABG/OPCAB in Iceland from June 2002
to February 2005. There were 279 patients that were divided into two groups, an obese group (defined as BMI >
30 kg/m2) (28%), and a non-obese group (BMI ≤30 kg/m2) (72%). Demographics, risk factors, complications and
operative mortality (OM) of both groups were compared.
Results
Patient demographics were similar in both groups, including the rate of risk factors such as diabetes mellitus,
hypertension and hyperlipidemia (Table 1). Type of surgery (CABG vs. OPCAB) was also comparable, however,
EuroSCORE was significantly lower in the obese group and operation- and cross-clamp time longer. There were no
significant differences in rates of either major or minor complications and the same was true for OM. Hospital stay,
bleeding and transfusion requirements were also comparable between groups.
Conclusion
Obese patients seem to do as well as non-obese patients following coronary arterial revascularisation, at least
regarding short-term complications and OM. Because obese patients had significantly lower EuroSCOREs, the
effects of selection bias can´t be ruled out.
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