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Published on: March 27, 2018
Incomplete revascularization and long-term survival after coronary artery bypass surgery
Umberto Benedetto1, Mario Gaudino2, Antonino Di Franco2
1Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
Insights
Incomplete revascularization (IR) after coronary artery bypass grafting (CABG) has marginal impact on survival unless both the RCA and CX territories are unrevascularized. Off-pump CABG with IR significantly reduces long-term survival.
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes
- Patient Survival
Background:
- Incomplete revascularization (IR) is a concern after coronary artery bypass grafting (CABG).
- The interaction between IR and surgical technique (on-pump vs. off-pump) requires further investigation.
Purpose of the Study:
- To investigate the impact of IR on long-term survival after isolated CABG.
- To explore the interplay between IR and off-pump surgery.
Main Methods:
- Analysis of 13,701 patients with multivessel disease undergoing CABG, all receiving LITA-LAD graft.
- IR defined as unrevascularized RCA and/or CX territories.
- Propensity score matching applied to adjust for confounding factors.
Main Results:
- IR did not significantly increase all-cause death in the overall cohort (HR 1.09).
- Survival was significantly lower when both RCA and CX territories were unrevascularized (HR 2.15).
- IR after off-pump CABG was associated with higher mortality (HR 1.26), irrespective of the extent of IR.
Conclusions:
- IR has a marginal impact on survival with LITA-LAD grafts when only one territory is unrevascularized.
- Significant survival reduction occurs when both RCA and CX territories remain unrevascularized.
- IR after off-pump CABG is linked to poorer long-term survival, even with single-territory IR.
Background:
We sought to investigate the impact of incomplete revascularization (IR) on long-term survival after isolated coronary artery bypass grafting (CABG). The possible interaction between IR and off-pump surgery was also explored.
Methods:
A total of 13,701 patients with multivessel disease undergoing CABG were included in the analysis. All patients received left internal thoracic artery (LITA) to the left anterior descending artery (LAD) territory. IR was defined as at least one diseased arterial territory (right coronary artery [RCA] and/or circumflex [CX] artery) incompletely revascularized.
Results:
Overall, 3107 (22.7%) patients received IR. After propensity score matching, IR did not increase all-cause death in the overall group (HR 1.09; 95%CI 0.96-1.22; P=0.17). However, when both RCA and CX artery were incompletely revascularized, late survival was significantly lower (HR 2.15; 95%CI 1.57-2.93). IR was associated with a higher risk of death after off-pump (HR 1.26; 95%CI 1.05-1.49) regardless the extent of IR. After on-pump, IR significantly affected survival only when both RCA and CX artery only were incompletely revascularized (HR 2.32; 95%CI 1.27-4.22).
Conclusions:
The present analysis shows that in patients with LITA-LAD graft the impact of IR on survival is marginal when only one coronary territory is left ungrafted. When both the RCA and CX territory remain unrevascularized the survival rate is significantly reduced. IR after off-pump CABG is associated with significantly lower survival and affects long-term outcome even when only one coronary territory is not revascularized.
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