Preoperative white blood cell count and risk of 30-day readmission after cardiac surgery.

Approximately 1 in 5 patients undergoing cardiac surgery are readmitted within 30 days of discharge. Among the primary causes of readmission are infection and disease states susceptible to the inflammatory cascade, such as diabetes, chronic obstructive pulmonary disease, and gastrointestinal complications. Currently, it is not known if a patient's baseline inflammatory state measured by crude white blood cell (WBC) counts could predict 30-day readmission.

Impact of preoperative left ventricular ejection fraction on long-term survival after aortic valve replacement for aortic stenosis.

Background: The survival of patients who undergo aortic valve replacement (AVR) for severe aortic stenosis with reduced preoperative ejection fractions (EFs) is not well described in the literature.

Methods And Results: Patients undergoing AVR for severe aortic stenosis were analyzed using the Northern New England Cardiovascular Disease Study Group surgical registry. Patients were stratified by preoperative EF (≥50%, 40%-49%, and <40%) and concomitant coronary artery bypass grafting.

Limited blood transfusion does not impact survival in octogenarians undergoing cardiac operations.

Background: We previously reported that transfusion of 1 to 2 units of red blood cells (RBCs) confers a 16% increased hazard of late death after cardiac surgical treatment. We explored whether a similar effect existed among octogenarians.

Methods: We enrolled 17,026 consecutive adult patients undergoing cardiac operations from 2001 to 2008 in northern New England.

Defining patient-prosthesis mismatch and its effect on survival in patients with impaired ejection fraction.

Background: How best to define patient-prosthesis mismatch (PPM) continues to be debated. Over time, the indexed effective orifice area has become the most widely used method. However, the clinical relevance of PPM remains controversial.

Using biomarkers to improve the preoperative prediction of death in coronary artery bypass graft patients.

The current risk prediction models for mortality following coronary artery bypass graft (CABG) surgery have been developed on patient and disease characteristics alone. Improvements to these models potentially may be made through the analysis of biomarkers of unmeasured risk. We hypothesize that preoperative biomarkers reflecting myocardial damage, inflammation, and metabolic dysfunction are associated with an increased risk of mortality following CABG surgery and the use of biomarkers associated with these injuries will improve the Northern New England (NNE) CABG mortality risk prediction model.

Long-term outcomes of endoscopic vein harvesting after coronary artery bypass grafting.

Background: Use of endoscopic saphenous vein harvesting has developed into a routine surgical approach at many cardiothoracic surgical centers. The association between this technique and long-term morbidity and mortality has recently been called into question. The present report describes the use of open versus endoscopic vein harvesting and risk of mortality and repeat revascularization in northern New England during a time period (2001 to 2004) in which both techniques were being performed.

Cardiac surgery-associated acute kidney injury: a comparison of two consensus criteria.

Background: Cardiac surgery-related acute kidney injury has short- and long-term impact on patients' risk for further morbidity and mortality. Consensus statements have yielded criteria--such as the risk, injury, failure, loss, and end-stage kidney disease (RIFLE) criteria, and the Acute Kidney Injury Network (AKIN) criteria--to define the type and consequence of acute kidney injury. We sought to estimate the ability of both the RIFLE and and AKIN criteria to predict the risk of in-hospital mortality in the setting of cardiac surgery.

Rationalising the treatment of anaemia in cardiac surgery: short and mid-term results from a local quality improvement initiative.

Background: Transfusion of red blood cells, while often used for treating blood loss or haemodilution, is also associated with higher infection rates and mortality. The authors implemented an initiative to reduce variation in the number of perioperative transfusions associated with cardiac surgery.

Methods: The authors examined patients undergoing non-emergent cardiac surgery at a single centre from the third quarter 2004 to the second quarter 2007.

Transforming administrative data into real-time information in the Department of Surgery.

Background: Cardiothoracic surgical programmes face increasingly more complex procedures performed on evermore challenging patients. Public and private stakeholders are demanding these programmes report process-level and clinical outcomes as a mechanism for enabling quality assurance and informed clinical decision-making. Increasingly these measures are being tied to reimbursement and institutional accreditation.

Long-term survival of the very elderly undergoing aortic valve surgery.

Background: Increasing numbers of the very elderly are undergoing aortic valve procedures. We describe the short- and long-term survivorship for this cohort.

Methods And Results: We conducted a cohort study of 7584 consecutive patients undergoing open aortic valve surgery without (51.

Long-term survival after cardiac surgery is predicted by estimated glomerular filtration rate.

Background: Estimated glomerular filtration rate (eGFR) before coronary artery bypass graft (CABG) surgery is a key risk factor of in-hospital mortality. However, in patients with normal renal function before CABG, acute kidney injury develops after the procedure, making postoperative renal function assessment necessary for evaluation. Postoperative eGFR and its association with long-term survival have not been well studied.

Long-term survival of the very elderly undergoing coronary artery bypass grafting.

Background: Increasing numbers of the very elderly are undergoing coronary artery bypass graft surgery (CABG). Short-term results have been studied, but few data are available concerning long-term outcomes.

Methods: We conducted a cohort study of 54,397 consecutive patients undergoing primary, isolated CABG surgery between July 1, 1987, and June 30, 2006.

Long-term survival after surgery versus percutaneous intervention in octogenarians with multivessel coronary disease.

Background: There is limited information comparing long-term survival after percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients aged 80 years and older. We studied the long-term survival of octogenarians with multivessel coronary artery disease undergoing PCI or CABG who might have been candidates for either procedure.

Methods: We identified 1693 patients, aged 80 to 89, with two-vessel disease (57.

Multivariable prediction of renal insufficiency developing after cardiac surgery.

Background: Renal insufficiency after coronary artery bypass graft (CABG) surgery is associated with increased short-term and long-term mortality. We hypothesized that preoperative patient characteristics could be used to predict the patient-specific risk of developing postoperative renal insufficiency.

Methods And Results: Data were prospectively collected on 11,301 patients in northern New England who underwent isolated CABG surgery between 2001 and 2005.

Perioperative increases in serum creatinine are predictive of increased 90-day mortality after coronary artery bypass graft surgery.

Background: Impaired renal function after coronary artery bypass graft (CABG) surgery is a key risk factor for in-hospital mortality. However, perioperative increases in serum creatinine and the association with mortality has not been well-studied. We assessed the hypothesis that perioperative increases in creatinine are associated with increased 90-day mortality.

The preoperative intraaortic balloon pump in coronary bypass surgery: a lack of evidence of effectiveness.

Background: There is limited evidence demonstrating the effectiveness of preoperative intraaortic balloon pump (IABP) use in isolated coronary artery bypass graft (CABG) surgery. A single-center randomized trial demonstrated its benefit. We undertook a multicenter observational study to verify this finding.

Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England.

Background: Randomized trials comparing coronary artery bypass graft surgery (CABG) with percutaneous coronary interventions (PCIs) for patients with multivessel coronary disease (MVD) report similar long-term survival for CABG and PCI. These studies used a highly selected population of patients and providers, and their results may not be generalizable to actual care. Our goal in this study was to compare long-term survival of MVD patients treated with CABG vs PCI in contemporary practice.

Perioperative stroke and long-term survival after coronary bypass graft surgery.

Background: Stroke is a devastating complication of coronary artery bypass graft (CABG) surgery. In-hospital outcomes have been described, yet the long-term effect of stroke on mortality following CABG surgery has not been well studied.

Methods: We examined the survival of 35,733 consecutive patients undergoing isolated CABG surgery in northern New England from 1992 through 2001.

Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England.

Background: Predicting risk for aortic and mitral valve surgery is important both for informed consent of patients and objective review of surgical outcomes. Development of reliable prediction rules requires large data sets with appropriate risk factors that are available before surgery.

Methods: Data from eight Northern New England Medical Centers in the period January 1991 through December 2001 were analyzed on 8943 heart valve surgery patients aged 30 years and older.

A multicenter comparison of intraaortic balloon pump utilization in isolated coronary artery bypass graft surgery.

Background: Single-center studies suggest substantial variation in intraaortic balloon pump (IABP) utilization. Our purpose is to examine IABP utilization over time and across medical centers.

Methods: This was a prospective cohort of 29,961 consecutive patients undergoing isolated coronary artery bypass graft surgery, between 1995 and 2000, at 10 centers (eight in northern New England and two in Canada).

Stability of ascending aortic dilatation following aortic valve replacement.

Background: Replacement of the ascending aorta (Asc Ao) at the time of aortic valve replacement (AVR) is controversial because the risk of progressive dilatation following valve replacement is uncertain. Our aim was to determine the natural history of ascending aortic dilatation following AVR.

Methods And Results: We studied 185 patients undergoing AVR at our institution between 1992 and 1999.