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J Thorac Cardiovasc Surg 2003;126:1335-1344
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Decreasing significance of left ventricular dysfunction and reoperative surgery in predicting coronary artery bypass grafting–associated mortality: A twelve-year study

^a Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Department of Surgery, and the Heart and Stroke Foundation/Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada

Received for publication February 25, 2003; revisions received March 18, 2003; revisions received May 4, 2003; accepted for publication June 4, 2003.

^* Address for reprints: Terrence M. Yau, MD, MSc, Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, 13EN-239, 200 Elizabeth St, Toronto, Ontario, Canada, M5G 2C4
terry.yau{at}utoronto.ca

OBJECTIVES: Patients undergoing coronary artery bypass grafting are older and have greater comorbidity than those operated on previously. We evaluated the changes in the predictors of in-hospital mortality among patients undergoing coronary artery bypass grafting during the last 12 years.

METHODS: Data on demographic characteristics, preoperative risk factors, operative variables, and hospital outcomes were collected prospectively for all patients undergoing isolated coronary artery bypass grafting at a single institution from January 1, 1990, to December 31, 2001. To examine the effect of time on patient risk profiles and outcomes, we divided patients into three groups according to year of operation (1990-1993 n = 5171, 1994-1997 n = 5977, 1998-2001 n = 6893).

RESULTS: In-hospital mortality declined from 2.4% (1990-1993) to 1.2% (1998-2001, P < .0001). Left ventricular dysfunction, increasing age, female gender, hypertension, diabetes, cardiogenic shock, congestive heart failure, peripheral vascular disease, reoperative coronary artery bypass grafting, left main disease, and urgent surgery independently predicted in-hospital mortality in the entire cohort of 18,041 patients. Severe left ventricular dysfunction was the most significant predictor of in-hospital mortality in the 12-year cohort, but it had a declining influence with time (1990-1993 odds ratio 7.1, 1994-1997 odds ratio 5.1, 1998-2001 not statistically significant) because of improving outcomes. Reoperative coronary artery bypass grafting similarly decreased in significance as a predictor of mortality. Emergency coronary artery bypass grafting was performed less frequently in recent years, but the requirement for emergency surgery carried an increasing odds ratio for mortality.

CONCLUSIONS: Despite increasing patient age and comorbidity, improvements in perioperative management have reduced the significance of severe left ventricular dysfunction and reoperative coronary artery bypass grafting but not emergency surgery as predictors of in-hospital mortality.

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