Changes in Coronary Artery Bypass Grafting: A 10-Year Single-Center Analysis

Objectives: Trends in coronary artery bypass grafting (CABG) concerning the use of bilateral internal thoracic arteries (BITA), total arterial revascularization (TAR) and off-pump versus on-pump surgery in our center were recently reported. After implementation of the 2018 ESC/EACTS guidelines the further development in our institution was investigated.

Methods: We compared all patients undergoing CABG at our center from 2010 to 2019 (n = 5604). Patient characteristics, operative procedure and postoperative results were analyzed and retrospectively compared with previously gained data.

Result: Patients characteristics did not differ significantly (p > 0.05) between the years. Age (Ø 67.1 ± 0.5 [66.5–68.2]), the percentage of women (Ø 18.9% ± 2.3 [14.9–22.5%]), rate of previous myocardial infarction (Ø 22.6% ± 4.6 [16.9–30.6%]), previous PCI (Ø 23.9% ± 2.8 [19.9–28.8%]) and rate of re-do procedures (Ø 1.8% ± 0.8 [0.8–2.9%]) remained stable. The same applies to the fraction of patients with left main stenosis (Ø 39.1% ± 3.2 [32.5–42.4%]), patient BMI (Ø 25.7 ± 2.6 [19.7–28.3]) and emergency procedures (Ø 10.5% ± 1.9 [6.2–13.5%]). However, since 2010 the operative technique changed significantly at our department. On the one hand, the examination shows that the trend is unstable regarding off-pump surgery (OPCAB). Its employment increased first from 37.8% in 2010 to 50.1% in 2016 but decreased to 28.8% in 2017. Then it increased again to 41.8% in 2019 (p < 0.005). On the other hand, mean number of distal anastomoses (2.9 ± 1.1 vs. 2.4 ± 0.8, 2010 vs. 2019, p < 0.005) decreases whereas the practice of TAR continues rising (28.1% vs. 68.7%, 2010 vs. 2019, p < 0.001). Resternotomy rate (Ø 5.3% ± 1.9 [2.1–9.1%]) and postoperative stroke rate (Ø 1.4% ± 0.6 [0.4–2.9%]) did not change during years (p > 0.05) Also, hospital stay did not differ (Ø 8.2 ± 0.4 days [7.7–8.8]) and there was no change in 30-day mortality (Ø 1.5% ± 0.4 [1.1–3.3%]) (p > 0.05).

Conclusion: Following the guidelines on myocardial revascularization the surgical approach has continuously been adjusted at our center to achieve the known long-term benefits by the use of BITA and TAR. Therefore, the number of patients receiving TAR is constantly increasing. Although the use of OPCAB-technique seems to vary—most likely reflecting the high influence of individual surgical preference—and despite the more complex handling of arterial and sequential grafts, the perioperative risk still remained stable over the years.

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Publikationsverlauf

Artikel online veröffentlicht:
19. Februar 2021