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Do beating heart techniques applied to combined valve and graft operations reduce myocardial damage?

^a Department of Cardiothoracic Surgery, The Cardiothoracic Centre Liverpool, UK
^b Department of Clinical Governance, The Cardiothoracic Centre Liverpool, UK

*Corresponding author. Cardiac Surgery, The Cardiothoracic Centre NHS Trust, Thomas Drive, Liverpool L14 3PE, UK. Tel.: +44 151 228 1616; fax: +44 151 288 2371.

E-mail address: brian.fabri{at}ctc.nhs.uk (B.M. Fabri).

We examined the outcomes of combined beating heart CABG and valve surgery (hybrid) and compared these to conventional CABG and valve surgery (conventional). Between April 1997 and March 2006, 388 patients received combined CABG and valve surgery. Patient characteristics and cardiac enzyme release were collected prospectively. To account for differences in case-mix we used logistic regression to develop a propensity score for hybrid group membership and then performed a propensity-matched analysis. One hundred and forty patients underwent hybrid operation with a mean logistic EuroSCORE of 13.5%, compared to 248 who underwent conventional operation with a mean logistic EuroSCORE of 10.9% (P=0.006). Eighty-two patients from each group were successfully matched. The mean logistic EuroSCORE after matching was similar between the groups (11.3% vs. 12.9%; P=0.48). The median number of grafts per patient was also similar, three in each group (P=0.98). Post-op CK-MB levels were found to be significantly lower for hybrid patients (44 U/I vs. 29.5 U/I; P=0.037). In-hospital mortality was not statistically different (9.8% vs. 6.1%; P=0.39). Survival at 5 years was 74% for hybrid and 71% for conventional group (P=0.92). CK-MB levels in patients receiving hybrid CABG and valve surgery are reduced compared to conventional CABG and valve surgery.

Key Words: Hybrid CABG and valve surgery; CK-MB; Mortality