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dc.contributor.authorLitton, E.
dc.contributor.authorBass, F.
dc.contributor.authorDelaney, A.
dc.contributor.authorHillis, G.
dc.contributor.authorMarasco, S.
dc.contributor.authorMcGuinness, S.
dc.contributor.authorMyles, P.
dc.contributor.authorReid, Christopher
dc.contributor.authorSmith, J.
dc.identifier.citationLitton, E. and Bass, F. and Delaney, A. and Hillis, G. and Marasco, S. and McGuinness, S. and Myles, P. et al. 2018. Six-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study. Journal of Cardiothoracic and Vascular Anesthesia. 32 (5): pp. 2067-2073.

Objective: To inform the design of a pivotal randomized controlled trial of prophylactic intra-aortic balloon counterpulsation (IABC) in patients undergoing coronary artery bypass graft (CABG) at high risk of postoperative low cardiac output syndrome (LCOS). Design: Inception cohort study. Setting: A total of 13 established cardiac centers in Australia, Canada, New Zealand, and the United Kingdom. Participants: Adult patients were eligible for inclusion if they were listed for CABG surgery and had 2 or more LCOS risk factors (low ejection fraction, severe left main coronary artery disease, redo sternotomy, unstable angina). Interventions: Outcomes of interest were a composite outcome of in-hospital mortality, postoperative acute myocardial infarction (AMI), acute kidney injury (AKI), or stroke as well as 6-month vital status and quality of life using the EuroQol 5-dimensional questionnaire (EQ5D). Measurements and Main Results: The study included 136 participants over a 29-month period. Overall, in-hospital and 6-month mortality occurred in 7 (5%) and 11 (8%) participants, respectively. The composite outcome occurred in 60 (44%). The mean increase in EQ5D summary index at 6 mont hs was 0.10 (standard deviation 0.24, p = 0.01). Perioperative AMI, AKI, or stroke significantly decreased the odds of a clinically meaningful improvement in quality of life (odds ratio 0.32; 95% confidence interval 0.13-0.79; p = 0.014). Preoperative IABC was used in 39 participants and did not predict postoperative outcomes. Conclusions: The study identified a group of patients at risk of LCOS in whom CABG surgery was associated with a substantial burden of perioperative morbidity. Preoperative IABC use was variable, supporting the need for further research.

dc.publisherWB Saunders
dc.titleSix-Month Outcomes After High-Risk Coronary Artery Bypass Graft Surgery and Preoperative Intra-aortic Balloon Counterpulsation Use: An Inception Cohort Study
dc.typeJournal Article
dcterms.source.titleJournal of Cardiothoracic and Vascular Anesthesia
curtin.departmentSchool of Public Health
curtin.accessStatusFulltext not available

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