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Total arterial revascularization coronary artery bypass surgery in patients with atrial fibrillation
Michał Pasierski1, Karolina Czarnecka1, Jakub Staromłyński1
1Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Center of Postgraduate Medical Education, Warszawa, Poland.
Insights
Total arterial revascularization (TAR) improves long-term survival for patients undergoing coronary artery bypass grafting (CABG) with atrial fibrillation (AF). This surgical technique is safe and offers significant survival benefits, especially for younger, low-risk individuals.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Atrial Fibrillation Management
Background:
- Atrial fibrillation (AF) is a common comorbidity in patients undergoing coronary artery bypass grafting (CABG).
- AF in CABG patients is linked to poorer prognosis, but surgical technique's impact remains unclear.
Purpose of the Study:
- To investigate if total arterial revascularization (TAR) improves long-term outcomes in patients with preoperative AF.
- To compare survival rates between TAR and non-TAR approaches in this specific patient group.
Main Methods:
- Analysis of the HEIST registry data (2006-2019) including 4746 patients with preoperative AF undergoing CABG.
- Propensity score matching to create comparable groups of TAR and non-TAR patients.
- Median follow-up of 4.1 years to assess long-term survival.
Main Results:
- Propensity matching yielded 295 pairs of TAR vs. non-TAR patients.
- No significant difference in operative or 30-day mortality between groups.
- TAR was associated with a nearly 30% improvement in late survival (P=0.01).
Conclusions:
- Total arterial revascularization (TAR) is a safe surgical approach for CABG patients with preoperative atrial fibrillation (AF).
- TAR significantly improves long-term survival in this population.
- Survival benefits are most pronounced in younger, low-risk patients, particularly those undergoing off-pump CABG.
Background:
Atrial fibrillation (AF) is a relatively common comorbidity among patients referred for coronary artery bypass grafting (CABG) and is associated with poorer prognosis. However, little is known about how surgical technique influences survival in this population.
Aim:
The current analysis aimed to determine whether total arterial revascularization (TAR) is associated with improved long-term outcomes in patients with preoperative AF.
Methods:
We analyzed patients' data from the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. The registry, to date, involves five tertiary high-volume centers in Poland. Between 2006 and 2019, 4746 patients presented with preoperative AF and multivessel coronary artery disease and underwent CABG. We identified cases of TAR and used propensity score matching to determine non-TAR controls. Median follow-up was 4.1 years (interquartile range [IQR], 1.9-6.8 years).
Results:
Propensity matching resulted in 295 pairs of TAR vs. non-TAR. The mean (standard deviation [SD]) number of distal anastomoses was 2.5 (0.6) vs. 2.5 (0.6) (P = 0.94) respectively. Operative and 30-day mortality was not different between TAR and non-TAR patients (hazard ratio [HR] and 95% confidence intervals [CIs], 0.17 (0.02-1.38); P = 0.12 and 0.74 [0.40-1.35]; P = 0.33, respectively). By contrast, TAR was associated with nearly 30% improved late survival: HR, 0.72 (0.55-0.93); P = 0.01. This benefit was sustained in subgroup analyses, yet most pronounced in low-risk patients ( < 70 years old; EuroSCORE II < 2; no diabetes) and when off-pump CABG was performed.
Conclusions:
TAR in patients with preoperative AF is safe and associated with improved survival, with particular survival benefits in younger low-risk patients undergoing off-pump CABG.
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