Abstract
Background In patients eligible for coronary artery bypass grafting, no data assess the importance
of the Heart Team in programming the best surgical strategy for patients with diffuse
coronary artery disease (CAD). This study aims to determine the contribution of the
Heart Team in predicting the feasibility of coronary artery bypass graft and angiographic
surgical success in these patients based on visual angiographic analysis.
Methods Patients with diffuse and severe CAD undergoing incomplete coronary artery bypass
graft surgery were prospectively included. One-year postoperative coronary angiograms
were obtained to evaluate graft occlusion. Two clinical cardiologists, two cardiovascular
surgeons, and one interventional cardiologist retrospectively analyzed preoperative
angiograms. A subjective scale was applied at a single moment to quantify the chance
of successful coronary artery bypass grafting for each coronary territory with anatomical
indication for revascularization. Based on individual scores, the Heart Team's and
the specialists' scores were calculated and compared.
Results The examiners evaluated 154 coronary territories, of which 85 (55.2%) were protected.
The Heart Team's accuracy for predicting the angiographic success of the surgery was
74.9%, almost equal to that of the surgeons alone (73.2%). Only the interventional
cardiologist predicted left anterior descending territory grafting success. The Heart
Team had good specificity and reasonable sensitivity, and the surgeons had high sensitivity
and low specificity in predicting angiographic success.
Conclusion The multispecialty Heart Team achieved good accuracy in predicting the angiographic
coronary artery bypass graft success in patients with diffuse CAD, with a high specificity
and reasonable sensitivity.
Keywords
CABG - vascular graft - coronary artery disease - Heart Team - outcomes
