Recovery free of heart failure after acute coronary syndrome and coronary revascularization.

Aims: Previous studies have examined risk factors for the development of heart failure (HF) subsequent to acute coronary syndrome (ACS). Our study seeks to clarify the clinical variables that best characterize patients who remain free from HF after coronary artery bypass grafting (CABG) surgery for ACS to determine novel biological factors favouring freedom from HF in prospective translational studies.

Methods And Results: Nova Scotia residents (1995-2012) undergoing CABG within 3 weeks of ACS were included.

Cardiac troponin T is an important predictor of mortality after cardiac surgery.

Purpose: Serum troponin (cTnT) levels, a commonly measured biomarker of myocardial injury, has rarely been considered in risk models after cardiac surgery.

Materials And Methods: Retrospective study of patients undergoing any cardiac surgery between 2004 and 2012. Patients with a history of recent myocardial injury (<21 days) were excluded.

Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives.

Objectives: Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients' values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care.

Creation of a Scorecard to Predict In-Hospital Death in Patients Undergoing Operations for Acute Type A Aortic Dissection.

Background: This study evaluated preoperative predictors of in-hospital death for the surgical treatment of patients with acute type A aortic dissection (Type A) and created an easy-to-use scorecard to predict in-hospital death.

Methods: We reviewed retrospectively all consecutive patients who underwent operations for acute Type A between 1996 and 2011 at 2 tertiary care institutions. A logistic regression model was created to identify independent preoperative predictors of in-hospital death.

The Importance of Continued Quality Improvement Efforts in Monitoring Hospital-Acquired Infection Rates: A Cardiac Surgery Experience.

Background: Hospital-acquired infections have been suggested to affect patients' outcomes and raise health care costs. However, research regarding the change in rates and types of infections over time remains limited.

Methods: All patients who underwent cardiac surgical procedures from 1995 to 2012 at the Queen Elizabeth II Health Sciences Center in Halifax, Canada were identified.

Does more than a single chest tube for mediastinal drainage affect outcomes after cardiac surgery?

Background: The use of 1 or more mediastinal chest tubes has traditionally been routine for all cardiac surgery procedures to deal with bleeding. However, it remains unproven whether multiple chest tubes offer a benefit over a single chest tube.

Methods: All consecutive patients undergoing cardiac surgery (2005-2010) received at least 1 chest tube at the time of surgery based on surgeon preference.

A pilot randomized controlled trial comparing CABG surgery performed with total arterial grafts or without.

Objective: To date only a few randomized controlled studies have compared grafting strategies in patients with multi-vessel coronary disease. This study represents a pilot RCT designed to test the feasibility of a trial comparing conventional CABG performed with a LIMA-LAD plus saphenous vein grafts (LIMA+SVG) and CABG performed with total arterial grafting (TAG).

Methods: Consenting patients undergoing non-redo isolated CABG surgery at a single institution were randomized to TAG or LIMA+SVG groups.

Incomplete revascularization after coronary artery bypass graft operations is independently associated with worse long-term survival.

Background: Complete revascularization (CR) has been suggested to provide benefits to both early and long-term outcomes, but the magnitude of the benefit and frequency of incomplete revascularization (IR) after coronary artery bypass graft operations is rarely explored and is the subject of the present study.

Methods: All patients who underwent isolated bypass operations (March 1995 to September 2007) at the Queen Elizabeth II Health Sciences Center (Halifax, NS, Canada) were identified. Revascularization was considered complete if each significantly diseased territory received at least 1 graft.

Myocardium at risk is associated with adverse clinical events in women but not in men, after coronary artery bypass grafting.

Background: Women undergoing coronary artery bypass grafting (CABG) are at increased risk for morbidity and mortality. Factors responsible for this observation include smaller coronary size and delayed presentation. To date, no studies have examined the effect of the degree of myocardium at risk (MAR) on the relationship between female sex and adverse postoperative events.

The changing face of cardiac surgery: practice patterns and outcomes 2001-2010.

Background: Advances in cardiac surgical care have allowed for successful surgery in high-risk elderly patients. Advances in percutaneous coronary intervention (PCI) techniques and expanded indications for PCI have resulted in a decrease in referrals for coronary artery bypass grafting (CABG). Our objective was to document changes in practice patterns and outcomes in a single tertiary cardiac surgery centre serving a large geographic area.

Determinants of percutaneous coronary intervention vs coronary artery bypass grafting: an interprovincial comparison.

Background: Marked variation exists concerning the utilization of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The objective of this study was to examine differences in predictors of mode of revascularization across 3 provincial jurisdictions.

Methods: All patients who underwent PCI and isolated CABG in British Columbia, Alberta, and Nova Scotia between 1996 and 2007 were considered.

Development of a predictive model for major adverse cardiac events in a coronary artery bypass and valve population.

Background: Quality improvement initiatives in cardiac surgery largely rely on risk prediction models. Most often, these models include isolated populations and describe isolated end-points. However, with the changing clinical profile of the cardiac surgical patients, mixed populations models are required to accurately represent the majority of the surgical population.

Are intraoperative precursor events associated with postoperative major adverse events?

Objectives: Precursor events are undesirable events that can lead to a subsequent adverse event and have been associated with postoperative mortality. The purpose of the present study was to determine whether precursor events are associated with a composite endpoint of major adverse cardiac events (MACE) (death, acute renal failure, stroke, infection) in a low- to medium-risk coronary artery bypass grafting, valve, and valve plus coronary artery bypass grafting population. These events might be targets for strategies aimed at quality improvement.

New onset postoperative atrial fibrillation is associated with a long-term risk for stroke and death following cardiac surgery.

Background And Aim: We sought to evaluate the long-term impact of post-cardiac surgery atrial fibrillation on the risk of stroke and survival.

Methods: Patients undergoing isolated CABG surgery from April 1, 1995 to March 31, 2007 were identified (n = 8058). Long-term stroke data were compiled using Cox modeling adjusted for clinical characteristics comparing patients with new-onset atrial fibrillation (NwAfib) and those without.

The risks associated with aprotinin use: a retrospective study of cardiac cases in Nova Scotia.

Purpose: In light of the concerns about the safety of aprotinin, we wanted to determine if aprotinin use during cardiac surgery was associated with an increased risk of mortality and morbidity compared with the use of tranexamic acid (TXA). We hypothesized that use of aprotinin is associated with a higher risk of adverse outcomes than use of TXA in our patient population.

Methods: In this retrospective study at a single surgical centre, we examined primary in-hospital outcomes of postoperative mortality, new acute renal failure, and perioperative blood transfusion, and we also investigated secondary outcomes of stroke, infection, and prolonged stay in the intensive care unit (ICU).

Predicting in-hospital mortality after redo cardiac operations: development of a preoperative scorecard.

Background: The present study generated a risk model and an easy-to-use scorecard for the preoperative prediction of in-hospital mortality for patients undergoing redo cardiac operations.

Methods: All patients who underwent redo cardiac operations in which the initial and subsequent procedures were performed through a median sternotomy were included. A logistic regression model was created to identify independent preoperative predictors of in-hospital mortality.

Complete revascularization is compromised in off-pump coronary artery bypass grafting.

Objective: Patients who undergo off-pump coronary artery bypass grafting (OPCAB) commonly receive fewer bypass grafts and are more often incompletely revascularized compared with those receiving conventional coronary artery bypass (CCAB) recipients. Because this can compromise survival, we sought to determine whether patients undergoing OPCAB are incompletely revascularized and whether this affects long-term survival and freedom from cardiac events.

Methods: OPCAB cases (n = 411) performed from January 1, 1997 to June 30, 2003 were considered for inclusion and matching with 874 randomly selected, contemporary CCAB cases.

Bilateral internal thoracic artery grafting is superior to other forms of multiple arterial grafting in providing survival benefit after coronary bypass surgery.

Objective: The objective of this study was to examine the effect of arterial grafting on long-term coronary artery bypass grafting mortality.

Methods: Consecutive coronary artery bypass grafting surgeries performed at a single tertiary care center between 1995 and 2007 were reviewed. Long-term survival was compared among patients according to the type of arterial grafts used: no internal thoracic artery, single internal thoracic artery, single internal thoracic artery with other arterial graft, or bilateral internal thoracic artery.

Impact of preoperative angiotensin-converting enzyme inhibitor use on clinical outcomes after cardiac surgery.

Background: Controversy exists about whether preoperative angiotensin-converting enzyme inhibitor (ACEi) therapy is associated with adverse outcomes after coronary artery bypass grafting (CABG).

Methods: We analyzed the outcomes of consecutive patients who underwent isolated CABG between 1998 and 2007 at a single institution. We used multivariable models to examine the association between preoperative ACEi therapy and in-hospital and long-term outcomes.

Delirium: a cause for concern beyond the immediate postoperative period.

Background: Delirium is a common neurologic complication after cardiac surgery, and may be associated with increased morbidity and mortality. Research has focused on potential causes of delirium, with little attention to its sequelae.

Methods: Perioperative data were collected prospectively on all isolated cases of coronary artery bypass grafting (CABG) performed from 1995 to 2006 at a single center.

Should all patients be treated with an angiotensin-converting enzyme inhibitor after coronary artery bypass graft surgery? The impact of angiotensin-converting enzyme inhibitors, statins, and β-blockers after coronary artery bypass graft surgery.

Background: We sought to evaluate the association between angiotensin-converting enzyme (ACE) inhibitors and outcomes after coronary artery bypass graft surgery (CABG).

Methods: Postoperative outpatient utilization of ACE inhibitors, statins, and β-blockers was assessed in a cohort of 3,718 patients after CABG 65 years and older. The primary outcome was freedom from a composite of all-cause mortality or hospital readmission for cardiac events or procedures.

Predictors of implantable cardioverter-defibrillator use in patients with ischemic cardiomyopathy.

Objectives: The objective of this study was to identify and examine ICD utilization in a large group of eligible coronary artery bypass grafting (CABG) patients with impaired left ventricular function.

Methods: We conducted a retrospective study of ICD eligible patients who had previously undergone CABG surgery between March 1, 1995 and June 30, 2008 at a single tertiary care institution. All patients with a pre-operative left ventricular ejection fraction (LVEF) ≤ 35% were considered ICD eligible.

Delirium as a predictor of sepsis in post-coronary artery bypass grafting patients: a retrospective cohort study.

Introduction: Delirium is the most common neurological complication following cardiac surgery. Much research has focused on potential causes of delirium; however, the sequelae of delirium have not been well investigated. The objective of this study was to investigate the relationship between delirium and sepsis post coronary artery bypass grafting (CABG) and to determine if delirium is a predictor of sepsis.

The impact of sequential grafting on clinical outcomes following coronary artery bypass grafting.

Objectives: Sequential anastomoses in coronary artery bypass grafting (CABG) offer theoretical advantages including increased graft flow and more complete revascularisation. However, published studies concerning the safety and efficacy of this technique are not definitive. The objective of this study was to assess the effect of sequential anastomoses on outcomes following CABG.

Impact of admission serum glucose level on in-hospital outcomes following coronary artery bypass grafting surgery.

Objective: The impact of admission serum glucose (SG) level on outcomes in coronary artery bypass grafting (CABG) surgery is unknown. The present study sought to determine whether elevated admission SG level is associated with adverse outcomes following CABG surgery.

Methods: Patients undergoing CABG surgery between January 2000 and December 2005 at a single centre were identified (n=2856).