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Published on: March 27, 2018
Changing pattern of reoperative coronary artery bypass grafting: a 20-year study
Konstantinos Spiliotopoulos1, Manjula Maganti, Stephanie Brister
1Peter Munk Cardiac Centre, Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
Insights
Reoperative coronary artery bypass grafting (CABG) has declined, with increased percutaneous coronary intervention (PCI) use prior to redo CABG. Despite higher patient risk, outcomes remain stable, with shock and heart failure predicting mortality.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Health Services Research
Background:
- Reoperative coronary artery bypass grafting (CABG) rates have been declining.
- Investigating trends in redo CABG versus primary CABG and prior percutaneous coronary intervention (PCI) is crucial.
- Understanding shifts in preoperative risk profiles and predictors of operative death is essential.
Purpose of the Study:
- To analyze the prevalence of redo CABG and previous PCI over time.
- To evaluate changes in preoperative risk profiles for patients undergoing redo CABG.
- To identify independent predictors of operative mortality in reoperative CABG patients.
Main Methods:
- Prospective data collection on demographics, risk factors, and outcomes for isolated reoperative CABG patients from 1990-2009.
- Patients divided into four time intervals (1990-1994, 1995-1999, 2000-2004, 2005-2009) to assess temporal trends.
- Risk profiles and outcomes compared between two periods (1990-1999 and 2000-2009).
Main Results:
- Redo CABG prevalence decreased from 7.2% to 2.2% between 1990-1994 and 2005-2009.
- PCI use before redo CABG significantly increased from 14.5% to 26.6% over the study period.
- Increased prevalence of comorbidities (diabetes, dyslipidemia, hypertension, peripheral vascular disease, left main disease) observed; in-hospital mortality remained stable, while low cardiac output syndrome decreased.
Conclusions:
- Reoperative CABG has significantly decreased, partly due to increased PCI use before redo procedures.
- Despite an evolving, higher-risk patient profile, hospital outcomes for redo CABG have remained consistent.
- Preoperative shock and congestive heart failure are identified as the most significant predictors of operative mortality.
Background:
Fewer patients are undergoing reoperative coronary artery bypass grafting (CABG). We investigated the prevalence of redo vs primary CABG and previous percutaneous coronary intervention (PCI), changing trends in preoperative risk profiles, and independent predictors of operative death.
Methods:
Data on demographic characteristics, preoperative risk factors, and hospital outcomes were collected prospectively for patients undergoing isolated reoperative CABG from January 1, 1990, to December 31, 2009. To examine the effect of time on the prevalence of redo CABG cases and previous PCI, we divided patients into four groups: 1990 through 1994, 470; 1995 through 1999, 415; 2000 through 2004, 240; and 2005 through 2009, 79. To examine risk profiles and outcomes, we created two groups: 1990 through 1999, 885; 2000 through 2009, 319.
Results:
Redo CABG decreased from 7.2% (1990 through 1994) to 2.2% (2005 through 2009). PCI before redo CABG significantly increased from 14.5% (1990 through 1994) to 26.6% (2005 through 2009). Patients with diabetes, dyslipidemia, hypertension, peripheral vascular disease, and left main disease increased. In-hospital mortality did not change significantly, but postoperative low cardiac output syndrome dropped. Age (odds ratio [OR], 1.04), peripheral vascular disease (OR, 2), congestive heart failure (OR, 5.8), and preoperative shock (OR. 9.7) independently predicted higher operative mortality.
Conclusions:
Reoperative CABG has significantly decreased. The increased prevalence of PCI before redo CABG is one of the reasons. Despite an increasing risk profile, hospital outcomes have remained largely the same. Preoperative shock and congestive heart failure are the most important predictors of operative mortality.
