Trends in Isolated Coronary Artery Bypass Grafting: A Single Center Study

Sergei Amunts Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel Eyal Ran Nachum Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel Yigal Kassif Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel Erez Kachel Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel Ami Shinfeld Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel Alexander Lipey Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel Boris Orlov Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel Ehud Raanani Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel Jacob Lavee Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel

Background:  The advent of percutaneous coronary intervention in recent years has changed the characteristics of patients referred for coronary artery bypass grafting (CABG).

Objectives:  We aimed to define the changes in pre-operative and operative characteristics and patients outcomes during the last decade in patients undergoing isolated primary CABG.

Methods: We retrospectively reviewed our records of isolated CABG during the years 2005-2006 and 2012-2013. Demographics, operative characteristics, and postoperative outcomes were assessed and compared between these periods.

Results: During the years 2005-2006 and 2012-2013, 662 and 468 patients respectively underwent isolated primary CABG in our institution. Compared with the years 2005-2006, patients in 2012-2013 displayed increased incidence of obesity (BMI of 26.7 vs 28.5, p=0.004) and smoking (43.4 vs 53.4%, p=0.001), arrived in less stable angina presentation (13.2 vs 19%, p= 0.009), and had more advanced heart failure symptoms (NYHA Class ≥II: 75% vs. 80% p=0.01). The two groups were similar in age, gender, hypertension and diabetes mellitus parameters. The average number of distal anastomoses performed was lower in 2012-2013 (3.3 vs 2.9%, p <0.001) but the use of mammary grafts was higher (97 vs 99.5%, p=0.015) with a higher incidence of use of bilateral mammary arteries was higher in 2012-2013 (34.1 vs 58.4% , p < 0.001 ).The predicted Euroscore hospital mortality rate was significantly higher in 2012-2013 compared to 2005-2006 ( 4.6 vs 6%, p = 0.006). However, the observed hospital mortality rate was not significantly different between the two groups (2.2 vs 3%, p=NS). Furthermore, Kaplan-Meier survival analysis showed that at 1-year of follow-up mortality rates were similar between patients who underwent CABG in more recent vs. remote years (Figure).

Conclusions: In spite of significant increase in pre-operative risk factors and a significantly higher Euroscore in patients undergoing CABG in more recent years, hospital and short term mortality did not increase over the past decade, possibly due to improved operative techniques and increased mammary usage.

Presentation

Sergei Amunts