Changes in Coronary Artery Bypass Grafting 2010–2016: A Single-Center Analysis

Objectives: Recent trends in coronary artery bypass grafting (CABG) concerning use of bilateral internal thoracic arteries (BITA), total arterial revascularization (TAR) and off-pump versus on-pump surgery were reported. Is there a noticeable influence on operation procedures and early outcome in the last seven years?

Methods: We compared all patients undergoing CABG at our center from 2010 to 2016 (4219 patients). Patient characteristics, operative procedure and postoperative results were analyzed in the EQS-database.

Results: Mean age (67.2 ± 9.8), percentage of women (Ø 19.5%, 15.0–22.6%), previous myocardial infarction (Ø 36.8%, 41.4–32.8%), PCI (Ø 23.6%, 19.8–28.1%) and percentage of re-do procedures (Ø 1.8%) did not differ significantly (P>0.05) between years. The same applies to the portion of patients older than 79 years (8.1%), obese patients (BMI > 35: 6.1%) and emergency procedures (Ø 12%, 10.2–14.4%). The operative technique changed significantly at our department: Portion of off-pump surgery increased from 37.8% in 2010 to 50.1% in 2016 (p < 0.005). Mean number of distal anastomoses (2.9 ± 1.1 versus 2.3 ± 0.8, 2010 versus 2016, p < 0.005), mean number of grafts (2.6 ± 0.9 versus 2.0 ± 0.6, p < 0.005) and use of venous graft (72% versus 36.2%, p < 0.005) decreased whereas the number of distal arterial anastomoses (1.5 ± 0.8 versus 1.8 ± 0.9, p < 0.001) and the use of RITA (37% versus 56%, p < 0.001) increased significantly. We found a highly significant increase in the portion of patients who received TAR (27.3% versus 63.8%, 2010 versus 2016, p < 0.001) and the fraction of procedures without central anastomosis (34.9% versus 79.0%, p < 0.001). Resternotomy rate (Ø 5.9%, 8.9–4–4%) and postoperative stroke rate (Ø 1.3%, 0.4–1.9%) did not change during years (p>0.05), whereas postoperative use of IABP/ ECMO (3.7% versus 2.2%, 2010 versus 2016, p < 0.005) decreased significantly. Hospital stay did not differ (Ø 7.9 ± 5.4 days, p < 0.005) but an increase of discharges back home was found (55.5% versus 78.3%, 2010 versus 2016, p < 0.001). There was no change in hospital (Ø 1.8%, 2.2–1.1%, p > 0.05.) or 30-day mortality (Ø 2.4%, 3.3–1.1%, p > 0.05).

Conclusion: To achieve the reported long-term benefit of patients in CABG by the use of BITA and TAR, the operation procedure has clearly been adjusted over the past 7 years. Despite a more complex surgical handling of arterial and sequential grafts, the perioperative risk did not increase.