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Published on: March 27, 2018
Influence of preoperative variables upon the results of coronary artery bypass surgery
R W Hacker1, M Torka, J Von Der Emde
1Chirurgische Klinik mit Poliklinik der Universität Erlangen-Nurnberg, Maximiliansplatz, 8520 Erlangen, Germany.
Insights
This study on aorta-to-coronary artery bypass vein grafts found good long-term survival and symptom relief. However, impaired ventricular function negatively impacted late results, while early outcomes were unaffected by preoperative variables.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Vein Graft Patency
Background:
- Coronary artery bypass grafting (CABG) using vein grafts is a common treatment for coronary artery disease.
- Long-term outcomes and risk factors influencing success require continued investigation.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of aorta-to-coronary artery bypass vein grafts.
- To identify preoperative variables affecting early and late operative results.
Main Methods:
- Prospective follow-up of 1096 patients undergoing CABG with vein grafts for up to 4 years.
- Actuarial methods used for survival rate calculation.
- Analysis of ten preoperative variables for their impact on operative risk and late outcomes.
Main Results:
- Early mortality was 1.7%, with a 4-year survival rate of 93.1%.
- Incidence of peri-operative myocardial infarction was 1.9%; 94.4% of patients were infarct-free at 4 years.
- Angina relief was 85.7%, with 62.8% complete elimination. Impaired ventricular function negatively affected late mortality and infarction rates.
- Symptomatic improvement was greater in men than women.
Conclusions:
- Aorta-to-coronary artery bypass vein grafts demonstrate favorable early and 4-year outcomes regarding survival and myocardial infarction.
- Preoperative patient characteristics did not influence early operative risk.
- Impaired left ventricular function is a significant predictor of poorer late outcomes after CABG with vein grafts.
Abstract:
One thousand ninety-six consecutive patients who received aorta-to-coronary artery bypass vein grafts were followed up to 4 years postoperatively. The early mortality was 1.7%; the 4-year survival rate, computed by actuarial methods, was 93.1%; the incidence of peri-operative myocardial infarction was 1.9%. After 4 years, 94.4% of the patients were free of peri- and postoperative infarcts. Angina pectoris was relieved in 85.7% and eliminated in 62.8% of the survivors. An analysis of the effects of ten preoperative variables on operative results showed that operative risk (early mortality, perioperative myocardial infarction) was not influenced by any of the variables. Late results (4-year mortality, 4-year infarction rate), however, were negatively affected by impaired ventricular function. Symptomatic improvement was more pronounced in men than in women.
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