Coronary artery bypass grafting in young patients--insights into a distinct entity
Felix Fleissner1, Gregor Warnecke2, Serghei Cebotari3
1Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. Fleissner.Felix@mh-hannover.de.
Insights
Young patients undergoing coronary artery bypass grafting (CABG) often require urgent surgery. While total arterial revascularization offers long-term graft patency, it is not suitable for all. Early outcomes for CABG in this demographic are excellent, with low mortality.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Coronary Artery Disease Management
Background:
- Coronary artery bypass grafting (CABG) is the standard treatment for multi-vessel coronary artery disease (CAD).
- Younger patients (<50 years) with CAD requiring surgery may benefit from strategies prioritizing long-term graft patency.
Purpose of the Study:
- To analyze perioperative data and outcomes of patients under 50 years old undergoing CABG.
- To evaluate the feasibility of total arterial revascularization in this younger cohort.
Main Methods:
- Retrospective analysis of 126 patients under 50 who underwent CABG between January 2010 and August 2013.
- Evaluation of perioperative data, including urgency of surgery, graft type, and need for cardiac support.
- Assessment of in-hospital outcomes and mortality.
Main Results:
- The majority of young patients (73%) presented for urgent or emergency CABG (STEMI, NSTEMI, unstable angina).
- Total arterial revascularization was performed in 52% of cases; combined arterial and venous grafts in 43%; venous grafts in 12%.
- Overall in-hospital mortality was low at 1% (1 out of 126 patients).
Conclusions:
- Young patients (<50 years) with CAD frequently require urgent surgical revascularization.
- While total arterial revascularization is desirable for long-term patency, it's only feasible in about half of these young patients.
- Early outcomes for CABG in this young cohort are excellent, with very low in-hospital mortality.
Objectives:
Coronary artery bypass grafting (CABG) is the 'Gold Standard' for patients with multiple vessel coronary artery disease (CAD). Younger patients presenting with coronary artery disease requiring surgery may represent a distinct subgroup with the main goal for coronary revascularization being long term patency of the performed grafts to improve outcome.
Methods:
Between January 2010 and August 2013, 126 patients below the age of 50 years underwent CABG for CAD in our hospital. We retrospectively analyzed the perioperative data and evaluated patients' outcome.
Results:
In 25% of the patients CABG was performed as an emergency procedure for STEMI or NSTEMI within 36 hours. Another 27% of the patients were operated urgently for unstable angina or myocardial infarction within the last weeks and only 48% of the patients were purely elective cases. We performed only venous bypass grafts in 12%, total arterial revascularisation in 52% of all cases and combined venous and arterial revascularization in 43%. Six patients needed cardiac support using an extracorporeal membrane oxygenation (Mortality n = 1 out of 6) and 17 patients received an intraaortic ballon pump perioperativly. Patients received 2.8 ± 1 bypass grafts overall. Overall in-hospital mortality in this cohort was low with 1% (n = 1).
Conclusions:
In conclusion, the majority of the young patients below the age of 50 years present urgently for operative revascularization. Besides the potential advances regarding long term patency using total arterial revascularization, only about half of the young patients are feasible for this approach. Overall early outcome in this group is excellent with mortality below one percent.
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