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factors were compared based on the characteristics of the operated population, Ivanov et al. (5) have demonstrated that the application of a standard model may provide an inaccurate assessment of the performance of either Heart Surgery Units or single heart surgeons. The evaluation of data available to-day has certainly proved that the average mortality risk of patients undergoing heart surgery has been gradually increasing for at least In fact, over the last 20 years, patients undergoing bypass surgery have been older [Table 3] (average age increased from 58 to 65 years), with lower ejection fraction (a reduction from 62% to 49%), with more severe coronary heart disease, and a higher proportion of patients with left main disea- 20 years. For instance, when the Parsonnet model was applied to the surgical population of the Beth Israel Hospital in Newark (6) [Table 2], it was observed that the average risk of patients gradually increased from 6.5 (in 1988) to 9.6 (in 1994), while, in the population of the National Adult Cardiac Surgical Database Report (7), it increased from 5.0 (in 1996) to 6.0 (in 1999), and at the Cleveland Clinic Foundation (8) from 2.9 (in 1996) to 3.1 (in 1999). AUTHORS DATA EVENT SURGERY NO. RISK COLLECTION FACTORS 1) Kennedy (CASS) 1975-78 Death Only CABG 20 2) Parsonnet 1982-87 Death All 15 3) Higgins 1986-88 Death Only CABG 9 + complic. 4) O’Connor 1987-89 Death Only CABG 8 5) STS 1995 Death Only CABG 28 6) Hannan 1989-1992 Death Only CABG 14 7) Tuman 1990 Death + LOS All 11 + complic. 8) Tu (Ontario) 1991-93 Death + LOS All 6 + ICU + OSP. 9) Roques 1993 Death All 8 10) Euroscore 1995 Death All 17 Newark Beth National Adult Cardiac Cleveland Clinic YEAR Israel Hospital Surgical Database Foundation (Parsonnet) (Parsonnet) (Higgins) 1988 6.5 1989 6.7 1990 7.1 1991 8.9 1992 9.3 1993 9.6 1994 9.6 1995 1996 5.0 2.9 1997 5.0 3.0 1998 5.5 3.1 1999 6.0 3.1 se (an increase from 7% to 20%). They were operated in medical emergency conditions (increasing from 5% to 40%), and with major associated comorbidities (for instance, the rate of patients affected by renal failure increased from 2.5% to 4.2%). Table 4 shows the relationship between the P. Pinna Pintor et al. Risk prediction in heart surgery Tab. 1 General Characteristics of ten risk models. Tab. 2 Mean score of the mortality risk. 9
10 Giornale Italiano di Cardiologia Pratica It J Practice Cardiol Ottobre 2003 Tab. 3 Increase of the prevalence of some mortality risk factors for the coronary surgery from 1980 to 2000. Edwards FH, 2000 (9). Tab. 4 Incidence of hospital complications after isolated coronary artery bypass graft surgery (10). Tab. 5 Reduction of the total mortality for isolated CABG from 1991 to 2000 in three different casistics. increase from 1981-87 to 1993-95 of COPD, the neurological complications, of the need of intra balloon pumping and the decrease of wound infections. Meanwhile [Table 5] the mortality for isolated CABG decreased progressively. From the experience of the STS mortality rate fall from 3.8% in 1991 to 2.6% in 2000, in the Cleveland Clinic Experience from 6% in 1992 to 1.8 in 2000 and in the NACS from 2.4 in 1990 to 2.1 in 1999. This is the reason why recently models overestimate mortality risk [Tables 6,7]. PREVALENCE OF PATIENTS WITH: YEARS AGE MEAN RENAL EF LEFT MAIN NON ELECTIVE FAILURE (%) DISEASE (%) SURGERY (%) (%) 1980 58 62 7 5 2.5 1985 62 54 9 20 2.6 1990 64 52 11 26 2.7 1995 64 50 18 34 3.8 2000 65 49 20 40 4.2 6,0 % 5,0 4,0 3,0 2,0 1,0 0,0 1981-87 1988-92 1993-95 Neurological complications COPD Wound infection Intra-aortic balloon pumping SOCIETY OF CLEVELAND NATIONAL THORACIC CLINIC ADULT CARDIAC SURGEONS HEART CENTER DATABASE 1990 - - 2.4 1991 3.8 - 2.9 1992 3.6 6 2.7 1993 3.5 4 2.6 1994 3.5 4.9 2.7 1995 3.2 5.1 3.0 1996 3.1 4.1 2.6 1997 3.1 2 2.3 1998 3.0 2.1 2.2 1999 2.9 2.5 2.1 2000 2.6 1.8 -
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Page 4 and 5: Indice Editoriale Pag. 4 L. Pagliar
Page 6 and 7: il caso di ricordare che siamo nell
Page 8 and 9: Risk prediction in heart surgery: m
Page 12 and 13: Overestimation Mortality (%) Mortal
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Page 16 and 17: weeks and months later after discha
Page 18 and 19: Precocità degli interventi prevent
Page 20 and 21: NON FUMARE! FAI CONTENTO IL TUO CUO
Page 22 and 23: Aspetti clinici, diagnosi ECG, indi
Page 24 and 25: della frequenza. Le restanti tachic
Page 26 and 27: Aritmia Risposta alle manovre Modal
Page 28 and 29: Terapia Le alternative terapeutiche
Page 30 and 31: Le Figure 3,4 e 5 mostrano la local
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Page 42 and 43: Cooperazione biventricolare negli a
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Page 54 and 55: Prevenzione della morte improvvisa
Page 56 and 57: BIBLIOGRAFIA 1. Davies MJ. The card
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Nuovi paradigmi interpretativi dell
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9. Libby P. Molecular bases of the
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