Postoperative Neutrophil to Lymphocyte Ratio as an Overall Mortality Midterm Prognostic Factor following OPCAB Procedures

Background: Off-pump coronary artery bypass grafting (OPCAB) is believed to limit inflammatory reaction. Neutrophil to lymphocyte ratio (NLR) is one of the more common and easily accessible markers of inflammatory response. The aim of the study was to compare postoperative results of NLR with mid-term OPCAB results. Methods: In total, 224 patients (198 (88%) men and 26 (12%) women) with mean age 65 +/− 9 years who underwent OPCAB though median full sternotomy in our department in 2018 enrolled into the study. We scrupulously collected the postoperative mid-term results, including survival rate, clinical status and risk for major adverse events, and compared them with perioperative laboratory results. Results: A three-year follow-up was completed by 198 individuals (90% survival rate) with 12 (5%) showing major adverse cardiovascular (MACE) events risk. In the multivariable analysis, the laboratory parameters noticed on the 1st postoperative day were statistically significantly predictive of survival, including neutrophils (HR 1.59, 1.33–1.89 95%CI, p < 0.0001), platelets (HR 1.01, 1.01–1.01 95%CI, p = 0.0065), NLR (HR 1.47, 1.3–1.65 95%CI, p < 0.0001) and postoperative ejection fraction (HR 0.9, 0.87–0.95 95%CI, p < 0.0001). Conclusions: Postoperative NLR above 4.6, as an inflammatory reaction marker, is related to mid-term mortality in OPCAB patients

A risk score for predicting long-term mortality following off-pump coronary artery bypass grafting

Background: Off-pump coronary artery bypass grafting (OPCAB) comprises 15–30% of all bypass grafting surgeries. The currently available perioperative scores such as Euroscore and STS score do not specifically predict long-term mortality after off-pump procedures. The neutrophil-to-lymphocyte ratio (NLR) is one of the new, easily accessible markers of inflammation with proven predictive value in cardiovascular diseases. We aimed to develop the first risk score for long-term mortality after OPCAB and to determine if the perioperative value of NLR predicts long-term mortality in OPCAB patients. Methods: In total, 440 consecutive patients with multivessel stable coronary artery disease undergoing OPCAB were recruited. Differential leukocyte counts were obtained by a routine hematology analyzer. Data regarding mortality during a median follow-up time of 5.3 years were obtained from the Polish National Health Service database. An independent population of 242 patients served as a validation cohort. Results: All-cause mortality was influenced by different clinical risk factors. In multivariate regression analysis, chronic obstructive pulmonary disease, stroke history, post-operative NLR and LVEF were independent predictors of mortality. Combing all independent predictors predicted long-term all-cause mortality with 68.5% sensitivity and 71.5% specificity (AUC = 0.704, p < 0.001). After weighing these variables according to their estimates in a multivariate regression model, we developed a score to predict mortality in patients undergoing OPCAB (PREDICT-OPCAB Score, ranging from 0 to 10). Patients with a high score were at higher risk of mortality within the median 5.3 years of follow-up (score 0–3: 8.3%; 4–6: 27.0%; 7– 10: 40.0%; p < 0.001 for score 0–3 vs. 4–6 and 7–10). This association was confirmed in the validation cohort. Conclusions: We developed and validated the first simplified risk score to predict mortality following OPCAB based on easily accessible clinical factors. This risk score can be used when obtaining a patient’s informed consent and as an aid in determining treatment

Feasibility of clinical application of Perceval sutureless bioprostheses in emergency patients with unexpected intraoperative findings

Introduction: Sutureless aortic prostheses provide an attractive opportunity for high-risk patients with difficult surgical anatomy of the aortic root. Aim of the study: To assess the outcomes of emergent aortic valve replacement (AVR) with Perceval sutureless bioprostheses in a group of high-risk patients in whom their implantation had not been considered before surgery. Material and methods: Since 2018, 53 sutureless aortic bioprostheses have been implanted in our center. In this single-center retrospective study, 7 high-risk (median EuroSCORE II 9.43%) patients (4 women and 3 men; median age 63 [28 to 73] years) were identified to undergo emergent procedures. They were operated on for active endocarditis on the native valves with extensive destruction of the annulus (n = 4), endocarditis on a previously implanted bioprosthesis (n = 1), organizing thrombus of the mechanical valve (n = 1), and diffuse aortitis (n = 1). Implantation feasibility, as well as postprocedural mortality and morbidity, were evaluated. Results: The following sizes of bioprostheses were used: XL (n = 3); L (n = 2); M (n = 1), and S (n = 1). The median (minimum; maximum) cross-clamping aortic time was 64 (37; 73) minutes while cardiopulmonary bypass time was 86 (49; 188) minutes, respectively. All patients survived operations and the first 30 days. Two of them died in the hospital because of multiorgan failure on 35th and 45th postoperative days. The follow-up period ranging from 6 to 40 months was completed by all who were discharged alive. Conclusions: Despite the well-known advantages of sutureless valves, they can be also used successfully in patients in whom standard prosthesis implantation is either impossible or highly demanding, including emergency cases with unexpected intraoperative findings

Univariable analysis results.

Univariable analysis results.</p

Comparison of pre-operative and post-operative results between survivors and non-survivors groups.

Comparison of pre-operative and post-operative results between survivors and non-survivors groups.</p

Multivariable analysis results.

Multivariable analysis results.</p

Box-plot 1.

Preoperative significant parameters.</p

The receiver-operating characteristic curve for the pre-operative value of systemic inflammatory response index.

The receiver-operating characteristic curve for the pre-operative value of systemic inflammatory response index.</p