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Improve morbidity and mortality in coronary artery bypass graft surgery for severe atherosclerosis

Shinji Kanemitsu1, Sawaka Tanabe, Kensuke Ohue

  • 1Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan ; Division of Cardiovascular Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan.

Annals of Vascular Diseases
|April 5, 2013
PubMed

Insights

Patients with severe atherosclerosis undergoing coronary artery bypass grafting (CABG) experienced higher complication rates. Off-pump coronary artery bypass (OPCAB) surgery showed no neurologic events in this cohort, suggesting careful strategy selection is key.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Neurology

Background:

  • Atherosclerosis is a known risk factor for morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG).
  • Understanding outcomes and the impact of surgical techniques in patients with severe atherosclerosis is crucial for improving patient care.

Purpose of the Study:

  • To investigate the outcomes of CABG in patients with severe atherosclerosis.
  • To determine if specific surgical techniques can mitigate the risk of neurologic events in this patient population.

Main Methods:

  • A study of 225 consecutive patients undergoing elective isolated CABG.
  • Patients were categorized into two groups: severe atherosclerosis (Group A, 42 patients) and without severe atherosclerosis (Group N, 183 patients).
  • Outcomes were compared between the two groups, with a focus on surgical techniques like off-pump coronary artery bypass (OPCAB) and on-pump beating CABG.

Main Results:

  • Patients with severe atherosclerosis (Group A) had a higher incidence of deep sternal infection (7.1%) and stroke (2.4%) compared to Group N.
  • Off-pump coronary artery bypass (OPCAB) was the predominant technique used in both groups (85.7% in Group A, 96.2% in Group N).
  • Notably, no cerebral infarction or neurologic events were observed in the 212 patients who underwent OPCAB.

Conclusions:

  • Severe atherosclerotic disease is associated with a significantly greater prevalence of complications following OPCAB compared to patients without severe atherosclerosis.
  • Meticulous selection of surgical strategies is essential for preventing perioperative stroke and reducing overall mortality in CABG patients.
  • The findings highlight the importance of tailored surgical approaches for patients with complex atherosclerotic conditions undergoing CABG.
Abstract

Keywords:
atherosclerosiscomplicationscoronary artery bypass graftoff-pump coronary artery bypassstroke

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