Cardiovascular
Mixed venous oxygen saturation predicts short- and long-term outcome after coronary artery bypass grafting surgery: a retrospective cohort analysis

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Background

Complications of an inadequate haemodynamic state are a leading cause of morbidity and mortality after cardiac surgery. Unfortunately, commonly used methods to assess haemodynamic status are not well documented with respect to outcome. The aim of this study was to investigate SvO2 as a prognostic marker for short- and long-term outcome in a large unselected coronary artery bypass grafting (CABG) cohort and in subgroups with or without treatment for intraoperative heart failure.

Methods

Two thousand seven hundred and fifty-five consecutive CABG patients and subgroups comprising 344 patients with and 2411 patients without intraoperative heart failure, respectively, were investigated. SvO2 was routinely measured on admission to the intensive care unit (ICU). The mean (sd) follow-up was 10.2 (1.5) yr.

Results

The best cut-off for 30 day mortality related to heart failure based on receiver-operating characteristic analysis was SvO2 60.1%. Patients with SvO2 <60% had higher 30 day mortality (5.4% vs 1.0%; P<0.0001) and lower 5 yr survival (81.4% vs 90.5%; P<0.0001). The incidences of perioperative myocardial infarction, renal failure, and stroke were also significantly higher, leading to a longer ICU stay. Similar prognostic information was obtained in the subgroups that were admitted to ICU with or without treatment for intraoperative heart failure. In patients admitted to ICU without treatment for intraoperative heart failure and SvO2 ≥60%, 30 day mortality was 0.5% and 5 yr survival 92.1%.

Conclusions

SvO2 <60% on admission to ICU was related to worse short- and long-term outcome after CABG, regardless of whether the patients were admitted to ICU with or without treatment for intraoperative heart failure.

Key words

assessment, patient outcomes
coronary artery bypass grafting
patient monitoring
postoperative complications
survival rates

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