Preoperative statin treatment is associated with reduced postoperative mortality and morbidity in patients undergoing cardiac surgery: An 8-year retrospective cohort study

BackgroundCardiac surgical procedures can be associated with significant morbidity and mortality. Recently, it has been recognized that statins might induce multiple biologic effects independent of lipid lowering that could potentially ameliorate adverse surgical outcomes. Accordingly, this study tested the central hypothesis that pretreatment with statins before cardiac surgery would reduce adverse postoperative surgical outcomes.MethodsDemographic and outcomes data were collected retrospectively for 3829 patients admitted for planned cardiac surgery between February 1994 and December 2002. Statin pretreatment occurred in 1044 patients who were comparable with non–statin-pretreated (n = 2785) patients with regard to sex, race, and age. Primary outcomes examined included postoperative mortality (30-day) and a composite morbidity variable.ResultsThe odds of experiencing 30-day mortality and morbidity were significantly less in the statin-pretreated group, with unadjusted odds ratios of 0.43 (95% confidence interval [CI], 0.28-0.66) and 0.72 (95% CI, 0.61-0.86), respectively. Risk-adjusted odds ratios for mortality and morbidity were 0.55 (95% CI, 0.32-0.93) and 0.76 (95% CI, 0.62-0.94), respectively, by using a logistic regression model and 0.51 (95% CI, 0.27-0.94) and 0.71 (95% CI, 0.55-0.92), respectively, in the propensity-matched model, demonstrating significant reductions in 30-day morbidity and mortality. In a subsample of patients undergoing valve-only surgery (n = 716), fewer valve-only patients treated with statins experienced mortality, although these results were not statistically significant (1.96% vs 7.5%).ConclusionsThese findings indicate that statin pretreatment before cardiac surgery confers a protective effect with respect to postoperative outcomes

Plasmapheresis Techniques During Cardiac Surgery

Plasmapheresis is an aggressive autologous blood conservation method utilized in cardiac surgery to reduce patient exposure to homologous blood transfusion. Presently the three perioperative techniques which have been used clinically incorporate varying methodology in producing platelet rich plasma (PRP). However, no prospective randomized study has been made to concurrently examine the benefits of individual devices. Fifty-two consenting adult cardiac patients who met selection criteria were randomly assigned to one of three plasmapheresis devices: Plasma Saver (PS), Cell Saver (CS), and Autotrans 1000 (AT 1000). Following induction of anesthesia, 20% of each patient's estimated plasma volume was removed, stored and then reinfused following the reversal of heparin with protamine. One hundred and twenty-two parameters were measured for each patient. These included anthropomorphic, operative, cardiopulmonary bypass, and postoperative follow-up parameters. Indices of hemostasis were measured which included coagulation screens and thrombelastographic data. There were no differences between groups in all preoperative parameters including the volume of PRP removed. Fibrinogen levels in the PRP were 213.9 +/- 63, 219.4+/-73, and 188.9+/- 69mg/dl in groups PS,CS, and AT 1000 (p=NS), while platelet counts were 178.4 +/- 73, 121.6 +/- 85, and 210.6 +/- 77 109/L, respectively (p<.05 CS vs. AT). There were no differences in chest tube drainage, time on ventilator, or length of ICU stay between groups. However, patients in PS group had significantly lower discharge platelet counts than groups CS and AT 1000. Total homologous blood exposure rate (donor blood exposure per patient) was 8.2 units in group PS, 4.5 in CS, and 5.4 in AT 1000, (p=NS). The currently available techniques for perioperative PRP production differ in both methodology and platelet yield, although the difference did not result in significantly different patient postoperative outcome indices

Coronary Artery Bypass Grafting With and Without Cardiopulmonary Bypass: A Comparison Analysis

Coronary artery bypass grafting (CABG) using stabilization devices in place of the heart–lung machine is being performed on a wide range of patients. This study retrospectively compared the performance of off-pump coronary artery grafting bypass (OPCAB) with conventional bypass patients over the same 6-month period at The Medical University of South Carolina. Data were collected and compared from the National Cardiac Database of the Society of Thoracic Surgeons (STS). Parameters studied included age, gender, left ventricular ejection fraction (LVEF), previous myocardial infarction (MI), disease severity, number of grafts, complications, blood usage, ventilation times, operating room (OR) time, and hospital length of stay (LOS). There were no significant difference between the patient groups with regard to age, gender, LVEF, previous MI, predicted mortality, and LOS. Operative mortality was also similar in the two groups: conventional bypass 4/117 (3%) and OPCAB 2/86 (2%). The conventional bypass patients (CPB) had significantly (p < 0.05) more diseased vessels (2.9 vs. 2.6) and distal grafts (4.1 vs. 2.7), as compared to the OPCAB group. OPCAB procedures resulted in significantly (p < 0.05) lower mean OR time (365 min vs. 406 min) and reduced mean postoperative ventilation hours (3.4 vs. 8.3 hours), as compared to conventional bypass. There were significantly (p < 0.05) fewer blood transfusions in the OPCAB group (1.1 units vs. 2.4 units), and the percentage of patients transfused blood was significantly less (34.9% vs. 57.3%). Nine out of 95 (9.5%) of patients who presented for OPCAB were converted to conventional bypass. Although there may be potential benefits to OPCAB, further studies must be directed at determining those patients who would benefit most from CABG using the off-pump technique