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Coronary artery bypass grafting: Factors affecting outcomes
Ter-Er Kusu-Orkar1, Muhammed Kermali2, Nina Oguamanam3
1Department of Surgery, Queens Medical Center, Nottingham, UK.
Insights
Coronary artery bypass grafting (CABG) outcomes are influenced by patient factors like age, diabetes, and renal/heart failure. Optimizing surgical techniques and conduits, such as the left internal mammary artery, improves results.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Coronary artery bypass grafting (CABG) is a primary cardiac surgery procedure.
- Extensive research focuses on enhancing CABG outcomes.
- This review synthesizes key factors impacting modern CABG practice.
Purpose of the Study:
- To review and summarize critical factors influencing coronary artery bypass grafting outcomes.
- To identify preoperative, intraoperative, and postoperative elements affecting patient results.
Main Methods:
- Comprehensive literature search of major databases (PubMed, Ovid, SCOPUS, Embase, Google Scholar) up to July 2020.
- Inclusion criteria focused on studies discussing factors affecting CABG outcomes.
- Exclusion of case reports, expert opinions, and editorials.
Main Results:
- Preoperative factors like age, diabetes, and systolic hypertension significantly correlate with CABG mortality and morbidity.
- Renal and heart failure also predict poorer operative results.
- The left internal mammary artery conduit demonstrates superior outcomes compared to venous grafts; minimally invasive techniques show promise.
Conclusions:
- Numerous complex factors impact CABG outcomes and require further investigation.
- Larger clinical trials and multidisciplinary team optimization are crucial for improving long-term results.
Introduction:
Coronary artery bypass grafting forms the bulk of a cardiac surgeon's workload. An extensive amount of research has been undertaken to improve the outcomes of this procedure. This literature review aimed to summarize key areas that influence coronary artery bypass grafting in modern day practice.
Methods:
A comprehensive electronic search was done using PubMed, Ovid, SCOPUS, Embase and google scholar from inception to July 2020. Articles were included if they discussed factors affecting outcomes in coronary bypass grafting (CABG). Case reports, expert opinion, and editorials were excluded.
Results:
There are many factors that influence and predict outcomes following coronary artery bypass surgery. Age, diabetes, and isolated systolic hypertension were preoperative factors with strong correlation to mortality and morbidity rates post CABG. In addition to these, the degree of renal failure and heart failure correlated with poorer operative results. The use of the left internal mammary artery has transformed outcomes and has proven advantage over venous conduit use. Newer minimal invasive techniques have the potential to further optimize outcomes.
Conclusion:
The numerous and complex factors which impair outcomes following CABG need to be further researched and addressed using larger trials and possible optimization of multi-disciplinary team approach to further improve long term outcomes.
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