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Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the BYPASS Registry
Rodrigo Pereira Paez1, Nelson Américo Hossne Junior1, José Amalth do Espírito Santo2
1Hospital São Paulo, Escola Paulista de Medicina da Universidade Federal de São Paulo, (EPM - UNIFESP), São Paulo, SP, Brazil.
Insights
The BYPASS Registry analyzed 2292 patients undergoing coronary artery bypass grafting (CABG) in Brazil. This study provides insights into CABG patient profiles, surgical strategies, and outcomes, establishing a benchmark for improving cardiac surgery quality.
Area of Science:
- Cardiovascular Surgery
- Public Health
- Medical Informatics
Background:
- Coronary artery bypass grafting (CABG) is the most common heart surgery in Brazil.
- International guidelines advocate for national databases to track CABG practices and outcomes.
- The BYPASS Registry was established in 2015 to address this need in Brazil.
Purpose of the Study:
- To characterize the patient profile and risk factors for CABG in Brazil.
- To analyze the predominant surgical strategies employed in CABG procedures.
- To evaluate the outcomes of CABG patients using BYPASS Registry data.
Main Methods:
- A cross-sectional study design was utilized.
- Data from 2292 patients undergoing CABG, cataloged in the BYPASS Registry up to November 2018, were analyzed.
- Demographic, clinical, operative, and postoperative hospital outcome data were collected and examined.
Main Results:
- The study population was predominantly male (71%), with high rates of prior myocardial infarction (41.1%) and diabetes (42.5%).
- Most procedures involved cardiopulmonary bypass (87%) with cardioplegia for myocardial protection (95.2%).
- Operative mortality was 2.8%, and cerebrovascular accident incidence was 1.2%.
Conclusions:
- The BYPASS Registry provides a representative overview of CABG practice and outcomes in Brazil.
- The database serves as a crucial reference for evaluating therapeutic procedures and improving patient safety.
- Findings can inform the development of models to enhance the quality of surgical practice nationwide.
Introduction:
Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015.
Objective:
To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry.
Methods:
A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed.
Results:
Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%.
Conclusion:
CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.
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