Effect of diastolic dysfunction on early outcomes during elective off-pump coronary artery bypass grafting

A prospective observational study

Young Nam Youn, ChiYoung Shim, Hongseok Yang, Soonchang Hong, Namsik Chung, Kyung Jong Yoo

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Left ventricular diastolic dysfunction (DD) causes adverse outcomes after cardiac surgery; however, the effects of DD during off-pump coronary artery bypass grafting (OPCAB) are not well understood. We aimed to assess the influence of DD on early mortality and morbidity of patients undergoing OPCAB. Methods: This prospective observational study included 1,256 patients scheduled for elective OPCAB. The DD of the patients was assessed by transthoracic echocardiography and tissue Doppler imaging. The cohort was classified into four DD groups; normal, mild (relaxation abnormality), moderate (pseudonormal dysfunction), and severe (restrictive abnormality). Study endpoints were major adverse cardiac events and other complications. Multivariate logistic regression was used to evaluate the independent effect of DD on surgical outcomes. Results: The 1,256 patients were grouped as follows: normal diastolic function (n = 55, 4.4%), mild DD (n = 995, 79.2%), moderate DD (n = 169, 13.5%), and severe DD (n = 37, 2.9%). Operative strategy did not differ among groups. The prevalence of hypertension, diabetes mellitus, renal failure, low ejection fraction (<35%), myocardial infarction within 30 days, and European System of Cardiac Operative Risk Evaluation score greater than 5 increased significantly with more severe DD. No significant difference was found in 30-day major adverse cardiac events (normal, 1.8%; mild DD, 3.6%; moderate DD, 6.5%; severe DD, 5.4%; p = 0.23); however, postoperative renal failure, respiratory complications, respiratory failure, and prolonged hospitalization (more than 12 days: 75th percentile of the study cohort) increased with the severity of DD (p < 0.01). Multivariate analysis revealed that severe DD independently predicted respiratory complications (odds ratio 3.68, 95% confidence interval: 1.84 to 20.36, p = 0.01) and prolonged hospitalization (odds ratio 5.75, 95% confidence interval: 1.81 to 13.23, p < 0.01). Conclusions: Diastolic dysfunction does not affect 30-day major adverse cardiac events after elective OPCAB. However, severe DD independently predicts respiratory complications and prolonged hospitalization.

Original languageEnglish
Pages (from-to)587-593
Number of pages7
JournalAnnals of Thoracic Surgery
Volume92
Issue number2
DOIs
Publication statusPublished - 2011 Jan 1

Fingerprint

Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Observational Studies
Prospective Studies
Hospitalization
Renal Insufficiency
Odds Ratio
Confidence Intervals
Left Ventricular Dysfunction
Respiratory Insufficiency
Thoracic Surgery
Echocardiography
Diabetes Mellitus
Cohort Studies
Multivariate Analysis
Logistic Models
Myocardial Infarction
Hypertension
Morbidity
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Youn, Young Nam ; Shim, ChiYoung ; Yang, Hongseok ; Hong, Soonchang ; Chung, Namsik ; Yoo, Kyung Jong. / Effect of diastolic dysfunction on early outcomes during elective off-pump coronary artery bypass grafting : A prospective observational study. In: Annals of Thoracic Surgery. 2011 ; Vol. 92, No. 2. pp. 587-593.
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abstract = "Background: Left ventricular diastolic dysfunction (DD) causes adverse outcomes after cardiac surgery; however, the effects of DD during off-pump coronary artery bypass grafting (OPCAB) are not well understood. We aimed to assess the influence of DD on early mortality and morbidity of patients undergoing OPCAB. Methods: This prospective observational study included 1,256 patients scheduled for elective OPCAB. The DD of the patients was assessed by transthoracic echocardiography and tissue Doppler imaging. The cohort was classified into four DD groups; normal, mild (relaxation abnormality), moderate (pseudonormal dysfunction), and severe (restrictive abnormality). Study endpoints were major adverse cardiac events and other complications. Multivariate logistic regression was used to evaluate the independent effect of DD on surgical outcomes. Results: The 1,256 patients were grouped as follows: normal diastolic function (n = 55, 4.4{\%}), mild DD (n = 995, 79.2{\%}), moderate DD (n = 169, 13.5{\%}), and severe DD (n = 37, 2.9{\%}). Operative strategy did not differ among groups. The prevalence of hypertension, diabetes mellitus, renal failure, low ejection fraction (<35{\%}), myocardial infarction within 30 days, and European System of Cardiac Operative Risk Evaluation score greater than 5 increased significantly with more severe DD. No significant difference was found in 30-day major adverse cardiac events (normal, 1.8{\%}; mild DD, 3.6{\%}; moderate DD, 6.5{\%}; severe DD, 5.4{\%}; p = 0.23); however, postoperative renal failure, respiratory complications, respiratory failure, and prolonged hospitalization (more than 12 days: 75th percentile of the study cohort) increased with the severity of DD (p < 0.01). Multivariate analysis revealed that severe DD independently predicted respiratory complications (odds ratio 3.68, 95{\%} confidence interval: 1.84 to 20.36, p = 0.01) and prolonged hospitalization (odds ratio 5.75, 95{\%} confidence interval: 1.81 to 13.23, p < 0.01). Conclusions: Diastolic dysfunction does not affect 30-day major adverse cardiac events after elective OPCAB. However, severe DD independently predicts respiratory complications and prolonged hospitalization.",
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Effect of diastolic dysfunction on early outcomes during elective off-pump coronary artery bypass grafting : A prospective observational study. / Youn, Young Nam; Shim, ChiYoung; Yang, Hongseok; Hong, Soonchang; Chung, Namsik; Yoo, Kyung Jong.

In: Annals of Thoracic Surgery, Vol. 92, No. 2, 01.01.2011, p. 587-593.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of diastolic dysfunction on early outcomes during elective off-pump coronary artery bypass grafting

T2 - A prospective observational study

AU - Youn, Young Nam

AU - Shim, ChiYoung

AU - Yang, Hongseok

AU - Hong, Soonchang

AU - Chung, Namsik

AU - Yoo, Kyung Jong

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Background: Left ventricular diastolic dysfunction (DD) causes adverse outcomes after cardiac surgery; however, the effects of DD during off-pump coronary artery bypass grafting (OPCAB) are not well understood. We aimed to assess the influence of DD on early mortality and morbidity of patients undergoing OPCAB. Methods: This prospective observational study included 1,256 patients scheduled for elective OPCAB. The DD of the patients was assessed by transthoracic echocardiography and tissue Doppler imaging. The cohort was classified into four DD groups; normal, mild (relaxation abnormality), moderate (pseudonormal dysfunction), and severe (restrictive abnormality). Study endpoints were major adverse cardiac events and other complications. Multivariate logistic regression was used to evaluate the independent effect of DD on surgical outcomes. Results: The 1,256 patients were grouped as follows: normal diastolic function (n = 55, 4.4%), mild DD (n = 995, 79.2%), moderate DD (n = 169, 13.5%), and severe DD (n = 37, 2.9%). Operative strategy did not differ among groups. The prevalence of hypertension, diabetes mellitus, renal failure, low ejection fraction (<35%), myocardial infarction within 30 days, and European System of Cardiac Operative Risk Evaluation score greater than 5 increased significantly with more severe DD. No significant difference was found in 30-day major adverse cardiac events (normal, 1.8%; mild DD, 3.6%; moderate DD, 6.5%; severe DD, 5.4%; p = 0.23); however, postoperative renal failure, respiratory complications, respiratory failure, and prolonged hospitalization (more than 12 days: 75th percentile of the study cohort) increased with the severity of DD (p < 0.01). Multivariate analysis revealed that severe DD independently predicted respiratory complications (odds ratio 3.68, 95% confidence interval: 1.84 to 20.36, p = 0.01) and prolonged hospitalization (odds ratio 5.75, 95% confidence interval: 1.81 to 13.23, p < 0.01). Conclusions: Diastolic dysfunction does not affect 30-day major adverse cardiac events after elective OPCAB. However, severe DD independently predicts respiratory complications and prolonged hospitalization.

AB - Background: Left ventricular diastolic dysfunction (DD) causes adverse outcomes after cardiac surgery; however, the effects of DD during off-pump coronary artery bypass grafting (OPCAB) are not well understood. We aimed to assess the influence of DD on early mortality and morbidity of patients undergoing OPCAB. Methods: This prospective observational study included 1,256 patients scheduled for elective OPCAB. The DD of the patients was assessed by transthoracic echocardiography and tissue Doppler imaging. The cohort was classified into four DD groups; normal, mild (relaxation abnormality), moderate (pseudonormal dysfunction), and severe (restrictive abnormality). Study endpoints were major adverse cardiac events and other complications. Multivariate logistic regression was used to evaluate the independent effect of DD on surgical outcomes. Results: The 1,256 patients were grouped as follows: normal diastolic function (n = 55, 4.4%), mild DD (n = 995, 79.2%), moderate DD (n = 169, 13.5%), and severe DD (n = 37, 2.9%). Operative strategy did not differ among groups. The prevalence of hypertension, diabetes mellitus, renal failure, low ejection fraction (<35%), myocardial infarction within 30 days, and European System of Cardiac Operative Risk Evaluation score greater than 5 increased significantly with more severe DD. No significant difference was found in 30-day major adverse cardiac events (normal, 1.8%; mild DD, 3.6%; moderate DD, 6.5%; severe DD, 5.4%; p = 0.23); however, postoperative renal failure, respiratory complications, respiratory failure, and prolonged hospitalization (more than 12 days: 75th percentile of the study cohort) increased with the severity of DD (p < 0.01). Multivariate analysis revealed that severe DD independently predicted respiratory complications (odds ratio 3.68, 95% confidence interval: 1.84 to 20.36, p = 0.01) and prolonged hospitalization (odds ratio 5.75, 95% confidence interval: 1.81 to 13.23, p < 0.01). Conclusions: Diastolic dysfunction does not affect 30-day major adverse cardiac events after elective OPCAB. However, severe DD independently predicts respiratory complications and prolonged hospitalization.

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