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Long-term cardiac survival after reoperative coronary artery bypass grafting
1Department of Thoracic and Cardiac Surgery, 414, PO Box 9101, 6500 HB Nijmegen, The Netherlands. l.noyez@thorax.umcn.nl
Insights
Long-term cardiac survival after reoperative coronary artery bypass grafting (RECABG) is acceptable, especially for patients younger than 65. Impaired left ventricular function independently predicts late cardiac mortality in RECABG patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Long-term Patient Survival
Background:
- Reoperative coronary artery bypass grafting (RECABG) carries higher risks and less favorable outcomes than primary myocardial revascularization.
- Analyzing long-term survival is crucial for understanding the efficacy of RECABG.
Purpose of the Study:
- To analyze the long-term cardiac survival rates of patients undergoing RECABG.
- To identify predictors of late cardiac-related mortality after RECABG.
Main Methods:
- A cohort of 466 patients who survived the initial 6 months post-RECABG (1987-1998) were analyzed.
- Actuarial survival estimates were calculated, and pre- and peroperative variables were assessed for mortality prediction.
Main Results:
- Mean follow-up was 7.7 years with 95.6% completeness.
- 14-year cardiac survival was 60.2%. Survival was significantly better for patients under 65 years old.
- Impaired left ventricular function was the sole independent predictor of late cardiac mortality.
Conclusions:
- Long-term survival following RECABG is acceptable.
- Advanced age (>65 years) negatively impacts long-term cardiac survival post-RECABG.
- Impaired left ventricular function is the primary independent predictor of late cardiac mortality in this patient group.
Objective:
Despite advances in cardiac surgery, the risk of reoperative coronary artery bypass surgery (RECABG) still exceeds those of a primary myocardial revascularization and also the late results are not so favourable. In this study, long-term cardiac survival is analyzed.
Methods:
We analyzed long-term cardiac survival of 466 patients who survived the first 6 months after a RECABG between January 1987 and December 1998. Actuarial survival estimates were calculated and pre- and peroperative variables were analyzed to identify predictors of long-term cardiac related mortality.
Results:
Mean follow-up was 7.7 +/- 3.8 years (1-17 years), and follow-up was 95.6% complete. One-year cardiac survival was 98.2%, 5-year: 91.0%, 10-year: 78.7% and 14-year survival 60.2%. Cardiac survival was only significantly superior for patients under 65 years of age at the moment of the RECABG. Impaired left ventricular function was identified as the only independent predictor of late cardiac-related mortality.
Conclusion:
The long-term survival in patients undergoing RECABG is acceptable. Once patients survived the first 6 postoperative months, advanced age (>65 years) is affecting long-term cardiac survival and impaired left ventricular function is the only independent predictor of late cardiac mortality.
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