Different characteristics of postoperative heart failure after surgery for aortic stenosis and coronary disease

Objective—Postoperative heart failure (PHF) remains a major determinant of outcome after cardiac surgery. However, possible differences in characteristics of PHF after valve surgery and coronary surgery (CABG) have received little attention. Therefore, this issue was studied in patients undergoing aortic valve replacement (AVR) and CABG, respectively.

Design—Three hundred and ninety‐eight patients undergoing isolated AVR for aortic stenosis were compared with 398 patients, matched for age and sex, undergoing on‐pump isolated CABG. Forty‐five AVR and 47 CABG patients required treatment for PHF and these were studied in detail.

Results—The AVR group had longer aortic cross‐clamp time and higher rate of isolated right ventricular heart failure postoperatively. Myocardial ischemia during induction and perioperative myocardial infarction were more common in the CABG group. One‐year mortality was 8.9% in the AVR group vs 25.5% in the CABG group (p?=?0.05).

Conclusions—The incidence of PHF was similar in both groups but different characteristics were found. Isolated right ventricular failure and PHF precipitated by septicemia were more common in AVR patients. PHF was more clearly associated with myocardial ischemia and infarction in CABG patients, which could explain their less favorable survival.     

Diagnostic accuracy of image postprocessing methods for the detection of coronary artery stenoses by using multidetector CT

PURPOSE: To retrospectively evaluate the diagnostic accuracy of multidetector computed tomography (CT) coronary angiography for detection of hemodynamically significant (>or=50%) stenoses by using various image postprocessing methods, with conventional coronary angiography as the reference standard. MATERIALS AND METHODS: The analysis used data from previous studies, use of which had been approved by the Institutional Review Board. Sixteen-section multidetector CT data sets for 40 patients (30 men, 10 women; mean age 56 years +/- 8; mean heart rate, 61 beats per minute +/- 6) were evaluated. Six independent investigators evaluated the data sets for the presence of stenoses with diameter reduction of 50% or more, by using either exclusively transverse images, free oblique multiplanar reconstructions (MPRs), free oblique maximum intensity projections (MIPs, 5 mm thick), prerendered curved MPRs, prerendered curved MIPs, or prerendered three-dimensional volume rendered reconstructions (VRTs). Evaluation results were compared with conventional coronary angiography for each artery in a blinded fashion (chi(2) test). RESULTS: Overall, 35 coronary artery stenoses were present. Percentage of evaluable arteries and accuracy for detecting stenosis (percentages of accurately classified arteries were, respectively, 99% and 88% for transverse, 99% and 91% for oblique MPR, 94% and 86% for oblique MIP, 94% and 83% for curved MIP, 93% and 81% for curved MPR, and 91% and 73% for VRT). Accuracy was significantly higher for oblique MPR than for curved MPR (P=.01), curved MIP (P=.03), and VRT (P<.001). CONCLUSION: The evaluation of multidetector CT coronary angiography with interactive image display methods, especially interactive oblique MPRs, permits higher diagnostic accuracy than evaluation of prerendered images (curved MPR, curved MIP, or VRT images).