Document Detail


Intraoperative regional myocardial acidosis and reduction in long-term survival after cardiac surgery.
MedLine Citation:
PMID:  15678049     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Regional myocardial acidosis, as measured with tissue pH electrodes during cardiac surgery, has been shown to be reflective of regional myocardial ischemia. This study examined the relationship between intraoperative regional myocardial acidosis and long-term survival of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: A total of 496 adult patients who underwent valve replacement, coronary artery revascularization, or both with intraoperative myocardial pH monitoring in the anterior and posterior left ventricular walls were followed up for 3 to 17 years (average 10.2 +/- 4.9 years) for all cause mortality. Regional myocardial acidosis in each patient was defined by the lower of the anterior and posterior wall pH values. RESULTS: A bivariate automatic interaction detection analysis identified three significant regional myocardial acidosis thresholds that affected long-term mortality: pH 37C less than 6.63 before aortic crossclamping, integrated mean pH 37C less than 6.34 during the period of aortic crossclamping, and pH 37C less than 6.73 at discontinuation of cardiopulmonary bypass. Cox proportional hazard regression analysis identified each of these thresholds to be independently determinant of survival, with pH 37C during aortic crossclamping having the highest risk ratio (risk ratio 2.15, 95% confidence interval 1.37-3.37). Raising pH 37C from lower than threshold before aortic crossclamping to higher than threshold during clamping increased the median survival by 40.2%. CONCLUSION: In adult patients undergoing cardiac surgery with cardiopulmonary bypass, regional myocardial ischemic acidosis before aortic crossclamping, during aortic crossclamping, and at discontinuation of cardiopulmonary bypass are independently associated with reduced long-term postoperative survival. Reversing or avoiding myocardial acidosis during cardiac surgery improves long-term patient survival.
Authors:
Shukri F Khuri; Nancy A Healey; Monir Hossain; Vladimir Birjiniuk; Michael D Crittenden; Miguel Josa; Patrick R Treanor; Samer F Najjar; Dharam J Kumbhani; William G Henderson
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  129     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-01-28     Completed Date:  2005-04-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  372-81     Citation Subset:  AIM; IM    
Affiliation:
Surgical Service, VA Boston Healthcare System, Boston, MA, USA. shukri.khuri@med.va.gov <shukri.khuri@med.va.gov>
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MeSH Terms
Descriptor/Qualifier:
Acidosis / mortality*
Adult
Aged
Aged, 80 and over
Cardiac Surgical Procedures*
Cardiomyopathies / mortality*
Cardiopulmonary Bypass
Female
Follow-Up Studies
Humans
Intraoperative Complications / mortality*
Male
Middle Aged
Multivariate Analysis
Postoperative Complications / etiology,  mortality
Predictive Value of Tests
Proportional Hazards Models
Risk Factors
Survival Analysis
Time
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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