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Clinical Outcomes of Complex Myocardial Revascularization

Clinical Outcomes of Complex Myocardial Revascularization. Caroline Hart 2 , Karen Dickson 3 , Ali Bell 4 , Dr. L. Dewar 1 , Dr. S. Korkola 1 , Dr. J. Tsang 1 , and Dr. A. Moustapha 1 1 Division of Cardiac Surgery, Regina Qu’Appelle Health Region 2 University of Saskatchewan

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Clinical Outcomes of Complex Myocardial Revascularization

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  1. Clinical Outcomes of Complex Myocardial Revascularization Caroline Hart2, Karen Dickson3, Ali Bell 4, Dr. L. Dewar1, Dr. S. Korkola1, Dr. J. Tsang1, and Dr. A. Moustapha1 1 Division of Cardiac Surgery, Regina Qu’Appelle Health Region 2 University of Saskatchewan 3 Health Information Management Services, Regina Qu’Appelle Health Region 4 Research & Performance Support, Regina Qu’Appelle Health Region

  2. Introduction

  3. Coronary artery disease

  4. Coronary Artery Bypass Grafting

  5. Study Rationale • An effective and superior method of treating coronary artery disease (CAD) is Coronary Artery Bypass Graft (CABG) surgery. • Patients who are older and have more extensive CAD, however, require more bypass grafts to achieve complete revascularization. • This study was designed to investigate whether there is an impact of more extensive revascularization surgery on morbidity and mortality rates in these patients.

  6. Does more extensive heart surgery result in a higher rate of death and complications?

  7. Methods • Design • A retrospective chart review was used to collect information on preoperative risk factors, intraoperative procedures and postoperative outcomes • Participants • All patients who underwent CABG between April 2006 and April 2007 at the Regina General Hospital were included. Patients who had open heart procedures with their CABG (e.g., heart valve repairs/ replacements) were excluded

  8. Methods • Procedure • Data were extracted from the APPROACH database in May 2007 • Patients were divided into two groups based on number of grafts and need for coronary artery endarterectomy (EA) and patch arterioplasty (PA): • simple group with CABG 1- 5 • complex group with CABG ≥6, or any CABG with EA or PA • Data Analysis • Data were analyzed using chi-square tests for nominal level data and independent t-tests where continuous data allowed. Non-parametric Mann-Whitney U tests were used when the data violated the assumptions for parametric analyses

  9. Results • Preoperative • Intraoperative • Postoperative

  10. Preoperative Results • Of 389 patients 74% required complex and 26% required simple revascularization • mean (SD) bypass grafts per patient of 6.65 (1.19) versus 4.24 (0.87) (P<0.001) • No significant differences: • Baseline factors • age, admission status, prior percutaneous coronary intervention, redo, ejection fraction, left main, rates of heavy calcification, small coronary arteries, and left ventricle aneurysm • Risk factors • diabetes, hypertension, congestive heart failure, myocardial infarction (MI), chronic obstructive pulmonary disease, peripheral vascular disease, cerebrovascular accident (CVA), renal failure, smoking or body weight

  11. Intraoperative Results • Patients in the complex group had more diffuse coronary artery disease, had longer surgeries (LOSurgery), and longer cardiopulmonary bypass (CPB) and aortic cross-clamp times (XCL)

  12. Postoperative Results • No significant differences in clinical outcomes were observed between groups. • The incidence of postoperative complications was low regardless of group

  13. Postoperative Results • Other postoperative complications were also similar between groups *for mediastinal bleed **χ2 = 1.0, df = 1, NS

  14. Postoperative Results • Despite undergoing significantly longer surgeries, patients in the complex group did not require longer length of stay • due to high variance, nonparametric tests were carried out but did not show significant differences between the two groups

  15. Conclusion

  16. Conclusion • Complex revascularization methods can be added to CABG to achieve complete revascularization without compromising patient outcomes and with excellent short-term results

  17. Clinical Relevance • Diffuse CAD should not deter surgeons from seeking complete revascularization • CABG should continue to be offered to patients who may require more extensive revascularization

  18. Acknowledgements • This project received funding from the University of Saskatchewan Dean’s Summer Student Research Program and the Mach Gaensslen Foundation

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