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Outcomes of coronary artery bypass grafting in patients with connective tissue diseases
Thomas J Birdas1, Jeffrey T Landis, David Haybron
1Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA. tbirdas1@aol.com
Insights
Coronary artery bypass grafting (CABG) is safe for patients with connective tissue diseases, offering good early survival. However, wound complications and need for reintervention are more common in this group.
Area of Science:
- Cardiology
- Rheumatology
- Surgical Outcomes
Background:
- Connective tissue diseases (CTDs) are associated with significant coronary artery disease (CAD) burden.
- Limited data exists on surgical management outcomes for CTD patients with CAD.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary artery bypass grafting (CABG) in patients with CTDs.
- To compare outcomes of CABG in CTD patients with a general surgical population.
Main Methods:
- Retrospective review of 44 CTD patients undergoing CABG (1995-2002).
- Demographic, perioperative, and postoperative data collected.
- Comparison with The Society of Thoracic Surgeons database.
Main Results:
- CTD patients were more likely women, used immunomodulating agents, and presented with severe angina (CCS Class IV).
- Higher incidence of inotropic agent use, intraaortic balloon pump, blood transfusions, and leg wound infections observed.
- Steroid/immunomodulating agent use correlated with increased postoperative complications.
- 3-year overall survival was 89%; freedom from reintervention was 75%.
Conclusions:
- CABG is a safe treatment for CTD patients with acceptable early outcomes.
- Increased risk of wound complications and need for reintervention noted in CTD population.
- Midterm results suggest less favorable outcomes compared to the general population.
Background:
Coronary artery disease represents a significant cause of morbidity and mortality in patients with connective tissue disease. Few reports exist on the results of surgical management of coronary artery disease in these patients.
Methods:
The medical records of patients with connective tissue diseases who underwent coronary artery bypass grafting at our institution between 1995 and 2002 were reviewed for demographic data, perioperative variables, and postoperative complications. The results were compared with data from The Society of Thoracic Surgeons database.
Results:
Forty-four patients were identified from a total of 5,496 cases during the study period (0.8%). There were 35 patients with rheumatoid arthritis, 8 with systemic lupus erythematosus, and 1 with scleroderma. Patients with connective tissue diseases were more likely to be women and use immunomodulating agents. They also had a higher incidence of Canadian Cardiovascular Society class IV angina, need for inotropic agents, need for intraaortic balloon pulsation, use of blood transfusions, and leg wound infections. The use of steroids or other immunomodulating agents was associated with increased postoperative complications. Mean follow-up was 35 months. The overall survival and freedom from reintervention at 3 years were 89% and 75%, respectively.
Conclusions:
Coronary artery bypass grafting is a safe treatment modality in patients with connective tissue diseases, with acceptable early results. Wound complications may be a problem in this patient population. Midterm results are less favorable, and reinterventions are frequently required.
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