• Alexander J Spanjersberg, Jan Paul Ottervanger, Arno P Nierich, Marga Hoogendoorn, and BruinsmaGeorge J Brandon BravoGJBBDepartment of Cardiothoracic Surgery, Isala Heart Centre, Isala Zwolle, The Netherlands..
• Division Cardiothoracic Anesthesiology, Department of Anesthesiology and Intensive Care, Isala Heart Centre, Isala Zwolle, The Netherlands. Electronic address: a.j.spanjersberg@isala.nl.
• J. Cardiothorac. Vasc. Anesth. 2022 Aug 1; 36 (8 Pt B): 295429602954-2960.

ObjectivesThe introduction and use of a preincision safety check were associated with lower mortality after mixed adult cardiac surgery; however, an explanatory mechanism is lacking. Stroke, one of the most severe complications after cardiac surgery, with high mortality, may be reduced by adapting the surgical handling of the ascending aorta. This study assessed the prevalence and predictors of this adaptation after a preincision safety check and the subsequent effect on outcome.DesignA prospective, single-center, observational study comparing adaptation with no-adaptation. The primary outcome measure was 30-day mortality. Multivariate analyses were performed to determine independent predictors of adaptation. To study the effect of adaptation on outcome, a propensity score-matched cohort was constructed in a 1:3 intervention:control ratio.SettingAt Isala Zwolle (NL), a large, nonacademic teaching hospital.ParticipantsAll consecutive cardiac surgery procedures from 2012 until 2015, including 4,752 surgeries.InterventionsThe adaptation of surgical handling of the ascending aorta.Measurements And Main ResultsIn 283 cardiac surgeries (5.9%), adaptation was indicated. The most important independent predictors for adaptation were extracardiac atherosclerosis, current smoking, and increasing age. In the propensity score-matched cohort consisting of 1,069 procedures, there were no significant differences in outcome. After correction for propensity score, the hazard ratio of adaptation for 30-day mortality was 1.8 (0.85-3.79).ConclusionsThe adaptation of aortic surgical handling after a preincision safety check was necessary for 5.9% of cardiac surgeries, with extracardiac atherosclerosis as the strongest predictor. Outcome was not significantly different between patients with and without adaptation. Although promising, it remains unclear whether adaptation may fully explain mortality reduction after the use of a preincision safety check.Copyright © 2022 Elsevier Inc. All rights reserved.

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