再バイパス術における冠動脈バイパス術のグラフト選択に関する全国的傾向
Bennet S Cho1, Nguyen K Le2, Troy Coaston2
1Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA; Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, UCLA, Los Angeles, CA.
Background:
Redo coronary arterial bypass grafting is a high-risk operation associated with significant morbidities. Although conduit selection remains a critical factor influencing post-coronary arterial bypass grafting outcomes, the trends in vessel utilization in redo operations remain poorly characterized. We used a nationally representative database to examine contemporary trends in conduit selection in redo versus first-time coronary arterial bypass grafting and risk factors of mortality among patients with repeat bypasses.
Methods:
Using the 2016-2021 Nationwide Readmissions Database, we identified adult patients undergoing isolated coronary arterial bypass grafting, stratified into First-time and Redo cohorts. The primary outcome was in-hospital mortality; secondary outcomes included perioperative complications, postoperative length of stay, hospitalization costs, nonhome discharge, and 30-day nonelective readmissions. Temporal trends in conduit use (internal mammary artery, radial artery, and saphenous vein) were assessed.
Results:
Among 928,925 patients, 5.3% underwent redo coronary arterial bypass grafting. From 2016 to 2021, the use of the internal mammary artery, radial artery, and saphenous vein increased in both cohorts (P < .001). Redo status was associated with higher likelihood of developing complications, longer length of stay (β + 6.2 days), and increased costs (β + $11,100), but lower odds of in-hospital mortality (adjusted odds ratio: 0.75). Internal mammary artery use was independently associated with reduced odds of mortality (adjusted odds ratio: 0.57).
Conclusion:
Redo coronary arterial bypass grafting is modestly increasing nationwide and remains associated with greater morbidity and resource use, compared with first-time coronary arterial bypass grafting. Nonetheless, adjusted mortality is lower in redo coronary arterial bypass grafting, potentially reflecting careful patient selection and intensive perioperative care. Arterial conduit use, especially internal mammary artery, may confer survival benefits and warrants further study in the redo setting.
