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Effects of smaller physical size on complex arterial grafting in coronary artery operations
H Nishida1, M Nakajima, K Ihashi
1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Insights
Arterial grafts in coronary artery bypass grafting are safe and effective for patients of all body sizes. Small body size did not increase operative risks or decrease long-term survival rates in this study.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) trends towards increased arterial graft utilization.
- Patient body size's impact on complex arterial grafting in CABG remains an area of investigation.
Purpose of the Study:
- To evaluate the effect of patient body size on outcomes of complex arterial grafting during CABG.
Main Methods:
- A cohort of 445 patients undergoing CABG with at least two arterial grafts was divided into two groups based on body surface area (BSA): <= 1.60 m² (Group A) and > 1.60 m² (Group B).
- Preoperative characteristics, early, and long-term outcomes were compared between groups.
Main Results:
- Group A (smaller BSA) had a higher prevalence of female patients and older age.
- No significant differences were observed in operative mortality (30-day: 2.6% vs 0.9%) or 3-year survival rates (93.8% vs 91.6%).
- Arterial graft patency at 1 month was comparable, while venous graft patency was lower in Group A (88.9% vs 97.7%).
Conclusions:
- Extensive arterial grafting in patients with smaller body size yields excellent long-term results.
- Patient body size does not appear to significantly increase operative mortality or morbidity in complex CABG procedures using arterial grafts.
Background:
The trend in coronary artery bypass grafting is for a gradual transition to the more extensive use of arterial grafts. This study was designed to investigate the effects of patient body size on complex arterial grafting in coronary artery bypass procedures.
Methods:
Four hundred forty-five patients who underwent coronary artery bypass grafting with two or more distal anastomoses using arterial grafts were divided into two groups according to body surface area: group A (n = 114), 1.60 m2 or less; and group B (n = 331), greater than 1.60 m2. Preoperative patient characteristics and early and long-term results were compared between the groups.
Results:
The prevalence of female sex (27% in group A versus 0.9% in group B; p < 0.0001) and age (62.7 +/- 8.1 years in group A versus 58.9 +/- 7.0 years in group B; p < 0.001) were significantly different. However, the prevalence of previous myocardial infarction and of left ventricular dysfunction and the extent of coronary artery disease were not significantly different. Three patients (2.6%) in group A and 3 patients (0.9%) in group B died within 30 days of operation (p = 0.18). The 1-month patency rate of arterial grafts was not significantly different (98.7% versus 96.7%; p = 0.16), but that of venous grafts was significantly lower in group A than in group B (88.9% versus 97.7%; p = 0.045). No significant difference was noted in the 3-year actuarial survival rate (93.8% versus 91.6%).
Conclusions:
The extensive use of arterial grafts in patients with small body size was associated with excellent long-term results, with no significant increase in operative mortality or morbidity.