European Journal of Cardio-Thoracic Surgery, Vol 12, 1-19, Copyright © 1997 by European Association for Cardio-thoracic Surgery
Validation and interdependence with patient-variables of the influence of procedural variables on early and late survival after CABG. K.U. Leuven Coronary Surgery Program
P Sergeant, E Blackstone and B Meyns
Cardiac Surgery Department, Gasthuisberg University Hospital, Leuven, Belgium. Paul.Sergeant@uz.kuleuven.ac.be
OBJECTIVE: First to identify the patient-, procedural- and surgical
experience variables influencing the early and late survival after CABG.
Second to identify patients likely to benefit, and those unlikely to
benefit, from technical details aimed at improving the results of coronary
artery bypass grafting (CABG). METHODS: A consecutive series of 9600
patients who underwent CABG using a variety of revascularization methods
between 1971 and 1992 were followed with 99.9% success. A multivariable
time-related analysis was performed. Patient-specific predictions and
nomograms were constructed from it to explore and validate the influences
and interdependences of patient- variables with variations in details of
the procedure. RESULTS: The 1-, 10- and 20-year risk-unadjusted survival
was 97, 81 and 50% respectively. Patient-variables influencing early
survival included severity of symptoms, patient presentation and extent of
coronary disease, while late survival was influenced importantly by left
ventricular function and cardiac and non-cardiac comorbidity. Technical
details of the operation influencing early survival included use of
endarterectomy, while details such as use of arterial grafting,
extensiveness of sequential grafting, completeness of revascularization and
extent of grafting to small coronaries influenced late survival to a highly
variable degree. CONCLUSION: The early survival is neither improved nor
worsened by single, multiple, sequential or complete arterial coronary
reconstruction. The late survival is modestly improved with the use of an
arterial graft to a major vessel, preferably but not exclusively to the
anterior descendens, except for patients with limited life-expectancy.
Differences in time-related survival with and without an arterial graft are
nearly the same across all levels of ejection fraction. No late beneficial
or detrimental effect was identified with more extensive use of arterial
reconstructive surgery in multisystem disease.
