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Clinical Characteristics and Mortality of Patients With Multivessel Coronary Disease Undergoing Coronary Artery Bypass Grafting Compared With Percutaneous Coronary Intervention: A Comparison Between 2 Multi-Centre Registries
Abstracts of the ASCTS 2008 Annual Scientific Meeting
503
disease and acute MI was only a predictor of mortality after PCI as was previous coronary surgery after CABG.
Poster Presentation
doi:10.1016/j.hlc.2010.04.116
Clinical Characteristics and Mortality of Patients With Multivessel Coronary Disease Undergoing Coronary Artery Bypass Grafting Compared With Percutaneous Coronary Intervention: A Comparison Between 2 MultiCentre Registries
Poster Presentation 38 Minimally Invasive Mitral Valve Surgery In Octogenarians Jurgen Passage ∗ , Joerg Seeburger, Nicolas Doll, Markus Czesla, Thomas Walther, Volkmar Falk, Friedrich Wilhelm Mohr Objective: Minimally invasive mitral valve surgery is of great interest. Here we report our experience with this procedure in octogenarians. Methods: Seventy-one patients (25 male/46 females) underwent elective mitral valve surgery via a right lateral mini-thoracotomy. Mean age was 82.1 ± 1.8 years. All patients were diagnosed with mitral regurgitation mean grade 3.0 ± 0.7, six patients had additional stenosis. Preoperative left ventricular ejection fraction was 59 ± 12%. The majority of patients were in New York Heart Association class III. Six patients (8.5%) had previously undergone mitral valve surgery. Cardiopulmonary bypass was conducted via the femoral vessels and the aorta was crossclamped with a transthoracic (Chitwood) clamp. Results: Mean operation time was 153 ± 44 min, CPB-duration 111 ± 43 min, and aortic-clamp time was 65 ± 33 min. Mitral valve repair was performed in 51 patients (72%), replacement in 20 patients (28%). Mitral valve repair techniques consisted mainly of ring annuloplasty (n = 49, mean ring size: 30.6 ± 2.8 mm), quadrangular resection of the PML (n = 9), and implantation of neochordae (n = 7 on AML, n = 16 on PML). Concomitant procedures were tricuspid valve surgery (n = 15), ablation for atrial fibrillation (n = 18), and closure of atrial septum defect (n = 4). Intraoperative course was uneventful in all patients. Mean duration of hospital stay was 18 ± 12 days. Stroke rate was 2.8% with 2 patients presenting with temporary neurological deficits. Early postoperative echocardiography revealed acceptable results in all cases. There was one reoperation due to bleeding from the apex. Thirty-day mortality rate was 4.2% (n = 3). Conclusion: Minimally invasive mitral valve surgery is safe and feasible in octogenarians and offers a true alternative to the conventional, full sternotomy approach. doi:10.1016/j.hlc.2010.04.117
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Christopher Reid ∗ , David Clark, Melanie Freeman, Nick Andrianopoulos, Angela Brennan, Diem Dinh, Brian Buxton, Julian Smith, Omar Farouque, Gil Shardey, Stephen J Duffy, Andrew E Ajani Department of Epidemiology and Preventive Medicine, Monash University; Austin Hospital, Alfred Hospital; Monash Medical Centre, Royal Melbourne Hospital, Victoria, Australia Background: The most appropriate method of revascularisation in patients with multivessel disease (MVD) remains debatable in the contemporary era. Methods: We compared the clinical characteristics and in-hospital, 30 day and 1 year mortality of 1309 consecutive patients undergoing primary coronary artery bypass grafting (CABG) versus 1094 consecutive patients undergoing percutaneous coronary intervention (PCI) for revascularisation of MVD, by comparing 2 large parallel multi-centre Australian registries (Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) and Melbourne Interventional group (MIG)) between October 2005 and June 2006. The 2 registries were merged (n = 2403) and combined predictors of 1-year mortality were determined by multivariate logistic regression. Results: The proportion of women was greater within the PCI group (26% vs 21%, p = 0.004), as was the incidence of renal failure with creatinine >0.2 mmol/L (7% vs 2%, p < 0.001), previous CABG (14% vs 3%, p < 0.001), and acute myocardial infarction (MI) within 24 h (23% vs 2%, p < 0.001). The CABG group had a higher incidence of diabetes (34% vs 26%, p < 0.001), hypertension (75% vs 66%, p < 0.001), congestive heart failure (14% vs 5%, p < 0.001) and peripheral vascular disease (14% vs 8%, p = 0.012). Age, body mass index, left ventricular ejection fraction, and the incidence of cardiogenic shock were similar between the 2 groups. There was no significant difference in in-hospital and 30-day mortality between the PCI and CABG registries but 1 year mortality was greater in the PCI group (5.6% vs 3.5%, p = 0.017). Revascularisation strategy (CABG, OR ± 95CI 1.0, 0.6–1.7), gender (1.1, 0.9–1.8) and diabetes (1.3, 0.8–2.1) were not significant predictors of 1 year mortality after combined multivariate analysis. Discussion: The baseline characteristics amongst patients undergoing CABG compared to PCI for multivessel coronary artery disease are different, but 1-year mortality is similar after adjustment. The presence of advanced age, renal failure, cardiogenic shock and recent MI are strong predictors of mortality. doi:10.1016/j.hlc.2010.04.118
ABSTRACTS
Heart, Lung and Circulation 2010;19:483–510
503
disease and acute MI was only a predictor of mortality after PCI as was previous coronary surgery after CABG.
Poster Presentation
doi:10.1016/j.hlc.2010.04.116
Clinical Characteristics and Mortality of Patients With Multivessel Coronary Disease Undergoing Coronary Artery Bypass Grafting Compared With Percutaneous Coronary Intervention: A Comparison Between 2 MultiCentre Registries
Poster Presentation 38 Minimally Invasive Mitral Valve Surgery In Octogenarians Jurgen Passage ∗ , Joerg Seeburger, Nicolas Doll, Markus Czesla, Thomas Walther, Volkmar Falk, Friedrich Wilhelm Mohr Objective: Minimally invasive mitral valve surgery is of great interest. Here we report our experience with this procedure in octogenarians. Methods: Seventy-one patients (25 male/46 females) underwent elective mitral valve surgery via a right lateral mini-thoracotomy. Mean age was 82.1 ± 1.8 years. All patients were diagnosed with mitral regurgitation mean grade 3.0 ± 0.7, six patients had additional stenosis. Preoperative left ventricular ejection fraction was 59 ± 12%. The majority of patients were in New York Heart Association class III. Six patients (8.5%) had previously undergone mitral valve surgery. Cardiopulmonary bypass was conducted via the femoral vessels and the aorta was crossclamped with a transthoracic (Chitwood) clamp. Results: Mean operation time was 153 ± 44 min, CPB-duration 111 ± 43 min, and aortic-clamp time was 65 ± 33 min. Mitral valve repair was performed in 51 patients (72%), replacement in 20 patients (28%). Mitral valve repair techniques consisted mainly of ring annuloplasty (n = 49, mean ring size: 30.6 ± 2.8 mm), quadrangular resection of the PML (n = 9), and implantation of neochordae (n = 7 on AML, n = 16 on PML). Concomitant procedures were tricuspid valve surgery (n = 15), ablation for atrial fibrillation (n = 18), and closure of atrial septum defect (n = 4). Intraoperative course was uneventful in all patients. Mean duration of hospital stay was 18 ± 12 days. Stroke rate was 2.8% with 2 patients presenting with temporary neurological deficits. Early postoperative echocardiography revealed acceptable results in all cases. There was one reoperation due to bleeding from the apex. Thirty-day mortality rate was 4.2% (n = 3). Conclusion: Minimally invasive mitral valve surgery is safe and feasible in octogenarians and offers a true alternative to the conventional, full sternotomy approach. doi:10.1016/j.hlc.2010.04.117
39
Christopher Reid ∗ , David Clark, Melanie Freeman, Nick Andrianopoulos, Angela Brennan, Diem Dinh, Brian Buxton, Julian Smith, Omar Farouque, Gil Shardey, Stephen J Duffy, Andrew E Ajani Department of Epidemiology and Preventive Medicine, Monash University; Austin Hospital, Alfred Hospital; Monash Medical Centre, Royal Melbourne Hospital, Victoria, Australia Background: The most appropriate method of revascularisation in patients with multivessel disease (MVD) remains debatable in the contemporary era. Methods: We compared the clinical characteristics and in-hospital, 30 day and 1 year mortality of 1309 consecutive patients undergoing primary coronary artery bypass grafting (CABG) versus 1094 consecutive patients undergoing percutaneous coronary intervention (PCI) for revascularisation of MVD, by comparing 2 large parallel multi-centre Australian registries (Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) and Melbourne Interventional group (MIG)) between October 2005 and June 2006. The 2 registries were merged (n = 2403) and combined predictors of 1-year mortality were determined by multivariate logistic regression. Results: The proportion of women was greater within the PCI group (26% vs 21%, p = 0.004), as was the incidence of renal failure with creatinine >0.2 mmol/L (7% vs 2%, p < 0.001), previous CABG (14% vs 3%, p < 0.001), and acute myocardial infarction (MI) within 24 h (23% vs 2%, p < 0.001). The CABG group had a higher incidence of diabetes (34% vs 26%, p < 0.001), hypertension (75% vs 66%, p < 0.001), congestive heart failure (14% vs 5%, p < 0.001) and peripheral vascular disease (14% vs 8%, p = 0.012). Age, body mass index, left ventricular ejection fraction, and the incidence of cardiogenic shock were similar between the 2 groups. There was no significant difference in in-hospital and 30-day mortality between the PCI and CABG registries but 1 year mortality was greater in the PCI group (5.6% vs 3.5%, p = 0.017). Revascularisation strategy (CABG, OR ± 95CI 1.0, 0.6–1.7), gender (1.1, 0.9–1.8) and diabetes (1.3, 0.8–2.1) were not significant predictors of 1 year mortality after combined multivariate analysis. Discussion: The baseline characteristics amongst patients undergoing CABG compared to PCI for multivessel coronary artery disease are different, but 1-year mortality is similar after adjustment. The presence of advanced age, renal failure, cardiogenic shock and recent MI are strong predictors of mortality. doi:10.1016/j.hlc.2010.04.118
ABSTRACTS
Heart, Lung and Circulation 2010;19:483–510