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[Cardiac factors predictive of 10-year survival after coronary surgery]
G Fournial1, J Fourcade, D Roux
1Service de chirurgie cardiovasculaire B, hôpital Rangueil, CHU de Toulouse.
Insights
Internal mammary artery bypass grafts significantly improve long-term survival after coronary artery surgery compared to saphenous vein grafts alone. Key predictors of poor outcomes include hypertension, incomplete revascularization, and not using the internal mammary artery-LAD graft.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Graft Patency and Longevity
Context:
- Predictors of long-term survival after coronary artery surgery are less understood than short-term mortality factors.
- A cohort of 480 patients aged 50-65 undergoing surgery between 1984-1986 were analyzed.
- Patients were divided into groups based on the use of internal mammary artery (IMA) grafts versus saphenous vein (SV) grafts.
Purpose:
- To evaluate the long-term survival outcomes associated with different bypass graft types in coronary artery surgery.
- To identify independent predictors of long-term mortality and morbidity following coronary artery bypass grafting.
Summary:
- Cardiac survival at 10 years was significantly higher with internal mammary artery-left anterior descending (IMA-LAD) bypass (91.4%) compared to SV grafts alone (79.6%).
- Univariate analysis revealed poor prognostic factors including three-vessel disease, left ventricular dysfunction, incomplete revascularization, use of SV grafts only, and perioperative infarction.
- Multivariate analysis identified non-use of IMA-LAD grafts, incomplete revascularization, and preoperative hypertension as independent predictors of long-term adverse outcomes.
Impact:
- Confirms the superior long-term benefits of IMA-LAD grafting in coronary artery bypass surgery.
- Highlights the detrimental impact of preoperative hypertension on long-term cardiac survival.
- Provides crucial data for optimizing surgical strategies and patient selection for improved long-term outcomes.
Abstract:
Although the predictive factors of postoperative mortality after coronary artery surgery are well known, those predictive of long-term survival have received less attention. This study reviews the outcome of a group of 480 patients between 50 and 65 years of age, operated between 1984 and 1986. The patients were classified in two groups according to the presence or absence of internal mammary artery bypass grafts: Group I (304 patients with saphenous vein bypass grafts alone) and group II (176 patients with an internal mammary artery +/- saphenous vein bypass grafts). The long-term results were assessed according to 3 criteria: isolated cardiac mortality: cardiac mortality associated with a repeat revascularisation procedure and cardiac mortality associated with reoperation or recurrence of angina. Cardiac survival at 10 years was significantly better after internal mammary-LAD bypass: 91.4% (CI 87.1-95.1) than after saphenous vein bypass grafting alone: 79.6% (CI 74.8-84.4) (p = 0.012). Univariate analysis identified the following poor predictive factors: three vessel disease (p = 0.03), preoperative left ventricular dysfunction with an ejection fraction inferior to 45% (p = 0.0001), incomplete revascularisation (p = 0.0003), use of venous bypass graft alone (p < 0.014) and perioperative infarction (p = 0.0254). For each criterion of survival (cardiac isolated or associated with a new revascularisation and/or recurrence of angina), multivariate analysis identified three independent predictive factors of long-term extramortality: not using internal mammary artery-LAD bypass graft, incomplete revascularisation and preoperative hypertension. This study confirms the beneficial effects of internal mammary-LAD artery grafting on long-term survival after coronary artery surgery, and also demonstrates the prejudicial effects of hypertension.