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Should coronary artery bypass grafting be performed at the same time as repair of a post-infarct ventricular septal
M J Dalrymple-Hay1, S M Langley, S A Sami
1Wessex Cardiothoracic Centre, Southampton General Hospital, UK.
Insights
Coronary artery bypass grafting (CABG) during ventricular septal defect (VSD) repair does not improve early mortality or long-term survival. Revascularization at the time of VSD repair appears unnecessary, with no survival benefit observed.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- Post-infarct ventricular septal defect (VSD) repair is a complex procedure.
- The role of concomitant coronary artery bypass grafting (CABG) in VSD repair is debated.
- Limited data exists on the impact of CABG on mortality and survival in these patients.
Purpose of the Study:
- To analyze the effect of CABG on early mortality following VSD repair.
- To evaluate the impact of CABG on long-term survival after VSD repair.
- To determine if concomitant CABG offers survival benefits in patients undergoing VSD repair.
Main Methods:
- Retrospective analysis of 150 patients undergoing VSD repair over 23 years.
- Patients were categorized based on the presence and extent of coronary artery disease (CAD) and whether CABG was performed.
- Logistic regression and Cox's proportional hazards model were used to assess mortality and survival.
- Coronary angiography was performed in 98 patients.
Main Results:
- Overall 30-day mortality was 32%.
- CABG did not significantly reduce operative mortality.
- No statistically significant differences in early mortality or actuarial survival were observed between groups with or without CABG.
- CABG was not associated with improved survival.
Conclusions:
- Concomitant CABG at the time of VSD repair does not impact early mortality.
- CABG does not confer survival benefits in patients undergoing VSD repair.
- Revascularization and coronary angiography may be unnecessary in this patient population.
Objective:
The value of coronary artery bypass grafting (CABG) at the time of repair of a post-infarct ventricular septal defect (VSD) remains controversial. The aim of this study was to analyse the effect of CABG on early mortality and survival following repair of an acquired VSD.
Methods:
Over 23 years, 179 patients, 118 male, 61 female, mean age 66 years (range 43-80), have undergone repair of a post-related VSD in our unit. A total of 29 patients, who predominantly form the earlier part of the series, were operated on greater than 1 month after the infarct and are, therefore, excluded. Coronary angiography was performed in 98 (65.3%) of the remaining 150 patients. Of these, 41 had coronary artery disease (CAD) limited to the infarct-related vessel and 57 had additional significant CAD. Those with CAD limited to the infarct-related vessel were not grafted (Group A). Of those, 40 with significant CAD underwent CABG at the time of VSD repair (Group B) and 17 did not (Group C). In 52 patients the coronary anatomy was not documented (Group D). Risk factors for early mortality were evaluated using logistic regression. Actuarial survival was compared using log rank and Wilcoxon tests. Cox's proportional hazards method was used to determine factors affecting survival.
Results:
Overall, 30 day mortality was 32%. CABG did not significantly decrease operative mortality (logistic regression). There was no statistically significant difference in early mortality or actuarial survival between the four groups. CABG was not associated with an increased survival (Cox's method).
Conclusions:
Concomitant CABG at the time of VSD repair does not affect early mortality nor confer survival benefits. There seems to be no demonstrable benefit in revascularisation at the time of repair and, therefore, it may be unnecessary to perform CABG or coronary angiography in these patients.