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Coronary bypass in vascular patients: a relatively high-risk procedure
C L Mesh1, B L Cmolik, D W Van Heekeren
1Division of Vascular Surgery, Case Western Reserve University, Cleveland, OH, USA.
Insights
Elective coronary artery bypass grafting (CABG) in patients with severe peripheral vascular disease (PVD) carries a significantly higher risk of major complications. This increased morbidity may impact the need for or timing of subsequent vascular reconstruction (VR).
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Risk Stratification
Background:
- Coronary artery bypass grafting (CABG) risk assessment assumes subsequent vascular reconstruction (VR) safety offsets CABG risks.
- Severe peripheral vascular disease (PVD) may complicate elective CABG procedures.
Purpose of the Study:
- To evaluate the risk of elective CABG in patients with severe PVD.
- To compare morbidity and mortality rates between PVD and non-PVD patients undergoing CABG.
Main Methods:
- A cohort study of 680 elective CABG patients (1993-1994).
- Prospective data collection on patient characteristics, operations, and outcomes.
- Retrospective review identified 58 patients with PVD indications or history for VR.
Main Results:
- Overall CABG mortality was 2.5%, with similar rates in PVD vs. non-PVD groups.
- Major morbidity was 3.6-fold higher in PVD patients (39.7%) vs. non-PVD patients (16.7%).
- Higher morbidity in PVD patients linked to aortoiliac and aortic aneurysmal disease.
Conclusions:
- Elective CABG in PVD patients is associated with substantial major morbidity.
- Significant morbidity may necessitate delaying or foregoing subsequent vascular reconstruction.
Abstract:
A premise of cardiac risk stratification is that the added risk of coronary artery bypass grafting (CABG) is offset by the improved safety of subsequent vascular reconstruction (VR). We questioned if elective CABG is patients with severe peripheral vascular disease (PVD) is a relatively high-risk procedure. A cohort study of 680 elective CABG patients from January 1993 to December 1994 was performed using three mutually exclusive outcomes of complication-free survival, morbidity, and mortality. Patient characteristic, operative, and outcome data were prospectively collected. Retrospective review determined that 58 patients had either a standard indication for or a history of VR. Overall CABG mortality was 2.5%, with statistically similar but relatively higher rates for PVD as compared to non-PVD patients. In contrast, major morbidity occurred at rates 3.6-fold higher in PVD patients (39.7%) than in disease-free patients (16.7%) after adjustment for the effects of patient and operative variables (odds ratio [OR] 3.67, 95% confidence interval [CI] 1.93-6.99). CABG morbidity in the PVD patient was most likely in those patients with aortoiliac (OR 9.51, CI 3.20-28.27) and aortic aneurysmal (OR 5.24, CI 1.28-21.41) disease types. CABG in PVD patients is associated with significant major morbidity. Such morbidity may preclude or alter the timing of subsequent VR.