New PhD on Patient-reported outcomes after on-pump and off-pump coronary artery bypass surgery

On January 20th 2010 Lars Mathisen defended his thesis from the Interventional Centre and Dept. of Thorasic and Cardiovascular Surgery, Oslo University Hospital, Rikshospitalet and Faculty of Medicine, University of Oslo. The evaluation committee consisted of 1.opponent professor, Emerita Judy Watt-Watson, Centre for Advanced Studies in Professional Practice, University of Torointo, Canada, 2. opponent professor Rune Haaverstad, Dept. of Thorasic Surgery, Haukeland University Hospital and committee leader profesor Theis Tønnessen, Dept. of Thorasic Surgery, Institute for Hospital Medicine, University of Oslo. The dissertation was lead by the University representative professor Lars Gullestad from Department of Cardiology, Institute for Hospital Medicine, University of Oslo. The quality of life studies performed by Lars Mathisen was based on follow-up studies of patients enrolled in the Off-pump project, a randomized clinical trial comparing off-pump and on-pump coronary artery bypass surgery. So far 5 PhD's has been produced by this project material. Abstact; ”Patient-reported outcomes after on-pump and off-pump coronary artery bypass surgery” Patients’ self-report of symptoms, health status and overall quality of life reflects the experience of ischemic heart disease, as well as the impact of coronary artery bypass surgery (CABG).

Conventionally, in order to immobilize the surgical field and to protect the heart, a heart-lung machine is used to oxygenate and transport blood during cardioplegic arrest. ‘Beating heart’ CABG may have a potential for improved patient-reported outcomes, possibly due to a lower incidence of neurological adverse effects believed to be associated with extracorporeal circulation. Between 1999 and 2002, 120 patients were randomly assigned to on-pump or off-pump CABG, and the patients responded to questionnaires before and 3, 6 and 12 months after surgery. Additionally, measurements of cardiac and cognitive function, and magnetic resonance imaging of the brain were entered in regression analyses with patient-reported outcomes. The experimental study demonstrated a benefit of surgical intervention but no significant difference in favour of on- or off-pump surgery. In descriptive and predictive studies, change in physical health was associated with separate contributions from change in exercise capacity and symptom relief, while mental health was associated with preoperative and change in cognitive function. A disadvantage to physical health at three months after surgery was suggested for on-pump patients with preoperative evidence of cerebral ischemic lesions. A methodological study supported that overall quality of life may be a cause as well as a consequence of general health perceptions. This thesis is significant for patient counselling before and after surgery, both in selection of surgical method and for understanding the variation in individual outcomes after CABG. Furthermore, common and unidirectional models appear inadequate to study the causal relationships between cardiac surgery and overall quality of life.

References:

Dissertation:
1) "Patient-reported outcomes after on-pump and off-pump coronary artery bypass surgery", avhandling for graden ph.d. (philosophiae doctor) ved Institutt for sykehusmedisin, Medisinsk fakultet, Universitetet I Oslo, januar 2010.

Published articles:
2) Mathisen L, Lingaas PS, Andersen MH, Hol PK, Fredriksen PM, Sundet K, Rokne B, Wahl AK, Fosse E. Changes in cardiac and cognitive function and self-reported outcomes at one year after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2009 Dec 15. [Epub ahead of print]

3) Mathisen L, Andersen MH, Veenstra M, Wahl AK, Hanestad BR, Fosse E. Quality of life can both influence and be an outcome of general health perceptions after heart surgery. Health Qual Life Outcomes. 2007 May 24;5:27.

4) Mathisen L, Andersen MH, Hol PK, Tennøe B, Lund C, Russell D, Lundblad R, Halvorsen S, Wahl AK, Hanestad BR, Fosse E. Preoperative cerebral ischemic lesions predict physical health status after on-pump coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2005 Dec;130(6):1691-7.

Mathisen L, Andersen MH, Hol PK, Lingaas PS, Lundblad R, Rein KA, Tønnessen TI, Mørk BE, Svennevig JL, Wahl AK, Hanestad BR, Fosse E. Patient-reported outcome after randomization to on-pump versus off-pump coronary artery surgery. Ann Thorac Surg. 2005 May;79(5):1584-9.