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Thorac Cardiovasc Surg 2021; 69(07): 584-591
DOI: 10.1055/s-0040-1718936
Original Cardiovascular

The Role of the Heart Team in Patients with Diffuse Coronary Artery Disease Undergoing Coronary Artery Bypass Grafting

Luciana Oliveira Cascaes Dourado
1   Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
,
Alexandre C. Pereira
1   Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
,
Nilson Tavares Poppi
1   Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
,
Rafael Cavalcante
1   Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
,
Fabio Gaiotto
1   Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
,
Luis Alberto Oliveira Dallan
1   Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
,
Marcio Sommer Bittencourt
2   Division of Internal Medicine, Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Sao Paulo, Brazil
,
Luiz Antonio M. Cesar
1   Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
,
Luis Henrique W. Gowdak
1   Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
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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

Authors' Contribution

Substantial contributions to the conception or design of the work (L. O. C. D., A. C. P., L. A. M. C., L. H. W. G.), or the acquisition and analysis (A. C. P., N. T. P., R. C., F. G., L. A. O. D.), or interpretation of data for the work (L. O. C. D., A. C. P., M. S. B., L. H. W. G.).


Drafting the work or revising it critically for important intellectual content (L. O. C. D., A. C. P., N. T. P., M. S. B., R. C., F. G., L. A. O. D., L. A. M. C., L. H. W. G.).


Final approval of the version to be published (L. O. C. D., A. C. P., N. T. P., M. S. B., R. C., F. G., L. A. O. D., L. A. M. C., L. H. W. G.


Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (L. O. C. D., A. C. P., N. T. P., M. S. B., R. C., F. G., L. A. O. D., L. A. M. C., L. H. W. G.).




Publication History

Received: 05 November 2019

Accepted: 28 August 2020

Article published online:
20 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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