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Current Impact of Cardiopulmonary Bypass in Coronary Artery Bypass Grafting in São Paulo State
Gabrielle Barbosa Borgomoni1, Omar Asdrúbal Vilca Mejia1,2, Bianca Maria Maglia Orlandi1
1Universidade de São Paulo - Faculdade de Medicina Hospital das Clínicas - Instituto do Coração, São Paulo, SP - Brasil.
Insights
Cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CABG) surgery is associated with reoperation for bleeding. This study evaluated CPB
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Research
Background:
- Cardiopulmonary bypass (CPB) use in coronary artery bypass grafting (CABG) presents challenges in patient treatment selection.
- Previous research has not definitively established the optimal approach for all patients undergoing CABG.
- The current context necessitates a clear understanding of CPB's impact on CABG outcomes.
Purpose of the Study:
- To evaluate the contemporary impact of cardiopulmonary bypass (CPB) on coronary artery bypass grafting (CABG) procedures.
- To analyze the association between CPB use and perioperative outcomes in CABG surgery within São Paulo State.
- To identify specific patient characteristics and procedural choices related to CPB utilization.
Main Methods:
- Analysis of 2905 consecutive CABG patients across 11 centers in São Paulo State, part of the REPLICCAR I registry.
- Inclusion of perioperative and follow-up data collected online by trained specialists.
- Statistical analysis of perioperative variables, procedure types, and outcomes (morbidity, operative mortality), with expected mortality calculated using EuroSCORE II (ESII).
Main Results:
- No significant age differences were observed between CPB and non-CPB groups (p=0.081).
- Patients with prior myocardial infarction and ventricular dysfunction were more likely to undergo surgery with CPB.
- Emergency or NYHA class IV patients were more likely to have surgery without CPB (p<0.001); CPB use was associated with reoperation for bleeding (p=0.012).
Conclusions:
- In the REPLICCAR registry, reoperation for bleeding emerged as the sole outcome significantly associated with CPB use in CABG.
- The findings highlight a specific postoperative complication linked to CPB, guiding future clinical decisions.
- Further research may explore strategies to mitigate bleeding complications in CABG patients requiring CPB.
Background:
Previous results on the use of cardiopulmonary bypass (CPB) have generated difficulties in choosing the best treatment for each patient undergoing myocardial revascularization surgery (CABG) in the current context.
Objective:
Evaluate the current impact of CPB in CABG in São Paulo State.
Methods:
A total of 2905 patients who underwent CABG were consecutively analyzed in 11 São Paulo State centers belonging to the São Paulo Registry of Cardiovascular Surgery (REPLICCAR) I. Perioperative and follow-up data were included online by trained specialists in each hospital. Associations of the perioperative variables with the type of procedure and with the outcomes were analyzed. The study outcomes were morbidity and operative mortality. The expected mortality was calculated using EuroSCORE II (ESII). The values of p <5% were considered significant.
Results:
There were no significant differences concerning the patients' age between the groups (p=0.081). 72.9% of the patients were males. Of the patients, 542 underwent surgery without CPB (18.7%). Of the preoperative characteristics, patients with previous myocardial infarction (p=0.005) and ventricular dysfunction (p=0.031) underwent surgery with CPB. However, emergency or New York Heart Association (NYHA) class IV patients underwent surgery without CPB (p<0.001). The ESII value was similar in both groups (p=0.427). In CABG without CPB, the radial graft was preferred (p<0.001), and in CABG with CPB the right mammary artery was the preferred one (p<0.001). In the postoperative period, CPB use was associated with reoperation for bleeding (p=0.012).
Conclusion:
Currently in the REPLICCAR, reoperation for bleeding was the only outcome associated with the use of CPB in CABG. (Arq Bras Cardiol. 2020; 115(4):595-601).
