Long-term follow up and outcome of coronary artery bypass grafting: retrospective study at Tbilisi Heart and Vascular Clinic

Abstract

Background: Traditional coronary artery bypass grafting (CABG) is performed with conventional method with middle sternotomy. The operation is done either on working heart or with cardiopulmonary bypass assistance. Coronary artery bypass grafting can be performed miniinvasively by latheral anterior thoracotomy (operation name: MIDCAB); at some circumstances endoscopic mobilization of graft and MIDCAB is combined (operation name: EndoACAB).  Hybrid revascularization strategy means combination of EndoACAB with percutaneus coronary intervention with stenting. The strategy plan depends of the patient characteristics, comorbidities and priority of the affected vessel.

Aim: Our aim was to retrospectively analyze long-term outcome and follow up period of patients who were operated on coronary vessels at Tbilisi Heart and Vascular Clinic.

Methods: All cases of the patients who had undergone urgent or planned CABG in 2015 - 2017 were studied retrospectively. Long term outcome was analyzed at 2.5-3 years after operation. Follow up period was assessed either after direct examination of patients, or by taking information from medical records. Preoperative characteristics of the patients, type of intervention applied, intraoperative peculiarities and long term results were studied. Results were statistically analyzed by statistical hypothesis testing with statistical level 5.

Results:  Totally 760 cases. Off-pump CABG was performed in 598 cases. Endo-ACAB with single vessel grafting was performed in 65 cases. In 97 patients hybrid revascularization strategy with multivessel revascularization was applied. Total lethal outcome was registered in 10 cases (1,3%) all of them in early post-operative period which was defined as 30 days after operation. No intraoperative mortality was seen.

Long term follow up was done in 422 cases: 275 from off-pump CABG group, 58 patients from EndoACAB group and 89 patients from hybrid revascularization group. 38 patients had at least one complains: malaise, tachypnoe, thoracic pain, acute complaints compatible for stenocardy. 7 patients showed echocardiographic deterioration: either myocardial hypo-akinesis or lowered ejection fraction compared to initial examination. These 45 patients underwent coronarography. According to coronarographic changes 7 patients out of 45 were in need of reintervention with PCI. Outcome was excellent with myocardial revascularization. In the rest 38 patients who underwent coronarography patency of conduit was excellent. During late follow up period no patients had been reoperated with CABG. Late postoperative mortality related to heart problems was not detected. If we compare rate of reintervention among the groups, off pump CABG group patients required reintervention with PCI in 5 cases (1.8% of the group total), hybrid revascularization group – 2 cases (2.2% of group total), and 0% of EndoACAB group patients. Statistical analysis showed no statistically significant difference in the rate of reintervention with PCI among the groups.

Conclusion: According to our data CABG operation and its renovated variants have had similarly good long- term outcome.