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Published on: March 27, 2018
Trends in isolated coronary artery bypass grafting over the last decade
Michel Kindo1, Tam Hoang Minh2, Stéphanie Perrier2
1Department of Cardiovascular Surgery, University Hospitals of Strasbourg, Strasbourg, France michel.kindo@chru-strasbourg.fr.
Insights
Extensive arterial grafts in coronary artery bypass grafting (CABG) show good early results despite increased patient risk. This surgical approach is not linked to higher hospital mortality or sternal complications.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Myocardial Revascularization
Background:
- Patient risk profiles for coronary artery bypass grafting (CABG) have increased over time.
- Older patient demographics, diabetes, and prior percutaneous coronary intervention are more prevalent.
- The EuroSCORE II, a measure of surgical risk, has significantly increased in recent years.
Purpose of the Study:
- To evaluate the impact of extensive myocardial revascularization using arterial grafts on hospital mortality and morbidity.
- To compare outcomes in patients undergoing isolated CABG between two distinct time periods.
Main Methods:
- A prospective perioperative database was used to compare two groups of isolated CABG patients.
- Group A (2000-2003; 898 patients) and Group B (2009-2012; 1249 patients) were analyzed.
- Baseline characteristics, operative details, and outcomes were compared between groups.
Main Results:
- The number of distal anastomoses, particularly with arterial grafts, significantly increased over time.
- In-hospital mortality remained low and did not differ significantly between groups (1.3% vs 2.4%).
- New-onset atrial fibrillation and deep sternal infection rates increased in the later group (Group B).
Conclusions:
- Extensive myocardial revascularization with arterial grafts is associated with favorable early outcomes.
- This approach is safe and effective even in patients with higher surgical risk profiles.
- Extensive arterial grafting was not identified as a risk factor for hospital mortality or sternal morbidity.
Objectives:
The purpose of this study was to assess the impact on hospital mortality and morbidity of extensive myocardial revascularization, using arterial grafts in patients undergoing isolated coronary artery bypass grafting (CABG).
Methods:
Our prospective perioperative database was used to define two groups of patients who underwent isolated CABG with cardiopulmonary bypass, based on the years in which the operation was performed: Group A (2000-2003; 898 patients) and Group B (2009-2012; 1249 patients). The baseline and operative characteristics and outcomes were compared.
Results:
Several significant changes in perioperative variables were observed. Group B included higher percentages of patients aged over 80 years (+58.1%), with diabetes (+32.0%) and with a history of percutaneous coronary intervention (+24.9%). The mean EuroSCORE II was significantly increased from 2.5 ± 4.4% in Group A to 3.2 ± 5.7% in Group B (P= 0.001). The mean number of distal anastomoses was significantly increased over time (total: 2.6 ± 0.8 vs 3.1 ± 1.0, P< 0.0001 and with arterial grafts: 1.6 ± 0.8 vs 2.6 ± 0.9, P< 0.0001). In-hospital mortality was low and did not significantly differ between Groups A and B (1.3 vs 2.4%; P= 0.08). Significant increases of new-onset atrial fibrillation (11.7 vs 21.9%, P= 0.017) and deep sternal infection (0.2 vs 1.1%, P= 0.017) were observed in Group B, compared with Group A. In multivariate analysis, extensive use of arterial grafts was not a risk factor of hospital mortality or sternal morbidity.
Conclusions:
Despite the increasing risk profiles of patients undergoing CABG, extensive myocardial revascularization using arterial grafts is associated with good early results.
