Trends in isolated coronary artery bypass grafting over the last decade

Abstract

OBJECTIVES: The purpose of this study was to assess the impact on hospital mortality and morbidity of extensive myocardial revascularization, using arterial grafts in patients undergoing isolated coronary artery bypass grafting (CABG). METHODS: Our prospective perioperative database was used to define two groups of patients who underwent isolated CABG with cardiopulmonary bypass, based on the years in which the operation was performed: Group A (2000 2003; 898 patients) and Group B (2009 2012; 1249 patients). The baseline and operative characteristics and outcomes were compared. RESULTS: Several significant changes in perioperative variables were observed. Group B included higher percentages of patients aged over 80 years (+58.1%), with diabetes (+32.0%) and with a history of percutaneous coronary intervention (+24.9%). The mean EuroSCORE II was significantly increased from 2.5 } 4.4% in Group A to 3.2 } 5.7% in Group B (P = 0.001). The mean number of distal anastomoses was significantly increased over time (total: 2.6 } 0.8 vs 3.1 } 1.0, P 0.0001 and with arterial grafts: 1.6 } 0.8 vs 2.6 } 0.9, P 0.0001). In-hospital mortality was low and did not significantly differ between Groups A and B (1.3 vs 2.4%; P = 0.08). Significant increases of new-onset atrial fibrillation (11.7 vs 21.9%, P = 0.017) and deep sternal infection (0.2 vs 1.1%, P = 0.017) were observed in Group B, compared with Group A. In multivariate analysis, extensive use of arterial grafts was not a risk factor of hospital mortality or sternal morbidity. CONCLUSIONS: Despite the increasing risk profiles of patients undergoing CABG, extensive myocardial revascularization using arterial grafts is associated with good early results.