Declining Impact of Reoperative Coronary Artery Bypass Grafting on Clinical Outcomes - The 68th Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Gal Aviel ¹ Nadav Rappoport ² David M. Shahian ³ Amit Korach ¹ Shai Carmi ⁴ John F. Keaney ⁵ Oz M. Shapira ¹

¹Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Israel
²Dept. of Software and Information Systems Engineering, Ben Gurion University of the Negev, Israel
³Division of Cardiac Surgery, Department of Surgery and The Center of Quality & Safety, Massachusetts General Hospital and Harvard Medical School, USA
⁴Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University, Israel
⁵The Division of Cardiovascular Medicine, Brigham and Women`s Hospital, USA

Background: Contemporary data on the risk of reoperative coronary artery bypass grafting (RECABG) are conflicting.

Objective: We sought to quantify the impact of reoperation on clinical outcomes of isolated CABG over the past two decades.

Methods: We compared the outcomes of 194,804 consecutive RECABG cases and 1,445,894 randomly-selected first-time CABG (FTCABG) cases (50% of total) reported to the Society of Thoracic Surgeons Adult Cardiac Surgery Database between 1999-2018. Primary outcomes were in-hospital mortality and overall morbidity. Using multiple logistic regression for each outcome for each year, we computed the annual trends of risk-adjusted odds-ratios (AOR) for the primary outcomes in the entire cohort and in 194,776 propensity-matched pairs.

Results: Annual participating center`s RECABG case volume declined by 68% (from a median of 25 {range 14-44} to a median of 8 {4-15}). Compared with FTCABG, RECABG patients were consistently older with higher proportions of co-morbidities. After propensity matching, primary outcomes of RECABG and FTCABG were similar (mortality: 3.5% vs. 2.3%, Standardized Difference {SD}=7.5%, morbidity: 40.7% vs. 40.3%, SD=0.9%). The annual AOR for mortality after RECABG declined during the study period from 1.93 (95% CI 1.73-2.16) to 1.22 (95% CI 0.92-1.62), and that of morbidity from 1.13 (95% CI 1.08-1.18) to 0.91 (95% CI 0.87-0.95), p

Conclusions:

The mortality and morbidity of RECABG have decreased substantially over time and now approach that of FTCABG. These data should be considered by multidisciplinary heart teams during shared-decision-making for patients being considered for RECABG.