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首页> 外文期刊>The heart surgery forum >Do patients in congestive cardiac failure undergoing cardiac surgery demonstrate worse outcomes compared with those with a history of cardiac failure?
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Do patients in congestive cardiac failure undergoing cardiac surgery demonstrate worse outcomes compared with those with a history of cardiac failure?

机译：与有心力衰竭史的患者相比，接受心脏手术的充血性心力衰竭患者是否显示出较差的结果？

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Cardiac surgery in patients with symptoms of congestive cardiac failure (CCF) carries a significant risk of mortality and morbidity. Except for emergencies and in unstable cases, the recommendation has been to delay the operation until the patient is fully recovered. The objective of this study was to determine the consequences of cardiac surgery in patients with acute decompensated heart failure and to compare their outcomes with the results of the operation in patients with previous CCF.We compared the outcomes of patients with CCF (n = 707) at the time of cardiac surgery (valve replacement or coronary artery bypass grafting [CABG]) with those with a history of CCF (n = 1583). The EuroSCORE was significantly higher in CCF patients (P < .001). Impaired renal function was also more commonly observed in patients with CCF (P < .001). After adjusting for preoperative characteristics, we compared the 2 groups with respect to postoperative complications, postoperative creatine kinase MB values, and in-hospital mortality.Before adjusting for preoperative characteristics, we found that in-hospital mortality (15.5%) and postoperative complications, such as arrhythmias (31%), renal failure (19%), stroke (4.7%), and myocardial infarction (MI) (3%), were significantly higher in the CCF group than in those with a previous history of CCF. When the patients were matched for preoperative characteristics, the rates of postoperative MI and arrhythmia were the main complications that were significantly higher in the CCF group, compared with the patients with previous CCF. The 2 groups were not significantly different with respect to in-hospital mortality. The results were not affected by the type of procedure (valve or CABG), and the main factor influencing mortality was the EuroSCORE.Despite the significant risk of mortality and morbidity in patients with current CCF, cardiac surgery to reverse the cause should not be delayed in these patients, because doing so may lead to further deterioration. Other risk factors, however, should be taken into consideration on an individual basis.
机译：患有充血性心力衰竭（CCF）症状的患者进行心脏手术会带来极大的死亡和发病风险。除紧急情况和不稳定情况外，建议将手术推迟到患者完全康复为止。这项研究的目的是确定急性失代偿性心力衰竭患者进行心脏手术的后果，并将其结果与先前有CCF的患者的手术结果进行比较。我们比较了CCF（n = 707）的患者的结果在有CCF病史（n = 1583）的心脏外科手术（瓣膜置换术或冠状动脉旁路移植术[CABG]）时。 CCF患者的EuroSCORE显着更高（P <.001）。 CCF患者也更常见肾功能受损（P <.001）。在调整术前特征后，我们将两组患者的术后并发症，术后肌酸激酶MB值和院内死亡率进行了比较。在对术前特征进行调整之前，我们发现院内死亡率（15.5％）和术后并发症， CCF组的心律失常（31％），肾衰竭（19％），中风（4.7％）和心肌梗塞（MI）（3％）等疾病的发生率明显高于有CCF既往史的患者。当患者的术前特征相匹配时，CCF组的术后并发症和心律失常的发生率显着高于先前的CCF患者。两组在院内死亡率方面无显着差异。结果不受手术类型（瓣膜或CABG）的影响，并且影响死亡率的主要因素是EuroSCORE。尽管当前CCF患者的死亡率和发病率存在重大风险，但不应延迟心脏手术来扭转病因在这些患者中，因为这样做可能导致进一步恶化。但是，应单独考虑其他风险因素。

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