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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Complete versus incomplete revascularization: long-term survival after CABG
Session:
CO - Prémio Machado Macedo
Speaker:
Rui j. Cerqueira
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.1 Cardiovascular Surgery – Coronary Arteries
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rui Cerqueira; Francisca Saraiva; Raquel Moreira; Ana Filipa Ferreira; Mário Jorge Amorim; Paulo Pinho; André Lourenço; Adelino Leite-Moreira
Abstract
<p>Background: There is conflicting evidence regarding the outcomes of complete revascularization (CR) in coronary artery bypass grafting (CABG).</p> <p>Aim: To compare long-term survival and early outcomes of CABG surgery using CR <em>vs</em> incomplete revascularization (IR).</p> <p>Methods: Retrospective single-center cohort study including consecutive patients who underwent 1<sup>st</sup> isolated CABG with at least 2-vessels disease, during a 10-year period. Emergent surgeries were excluded. An anatomical definition for completeness was used: CR was considered if all diseased territories (at least one branch with stenosis ≥50%) were revascularized with at least 1 graft (stent was also considered to right coronary artery hybrid procedures). Propensity scores (PS) were estimated through a non-parsimonious multivariate logistic regression model and included in multivariate regressions as a covariate along with CR. Cox and logistic regressions were used to estimate the effect of CR in long-term survival and early outcomes, respectively. Mean follow-up time was 7 years, maximum 13.</p> <p>Results: CR was performed in 47% out of 3154 included patients. Mean patient’s age was 64±10 y. and 80% were male. Patients with CR were younger (63±10 vs. 65±10, p<0.001) and presenting less frequently with 3-vessels disease (65% vs. 86%, p<0.001), chronic kidney disease (55% vs. 59%, p=0.045) and peripheral and cerebral artery disease (13% vs. 19%, p<0.001 and 7% vs. 11%, p<0.001, respectively). Regarding surgical variables, bilateral internal mammary artery was more often used in CR patients (39% vs. 28%, p<0.001), but no difference was found regarding the use of cardiopulmonary bypass (57% vs. 55%, p=0.346). Kaplan-Meier curves showed a significant benefit for CR patients with long-term cumulative survival of 66% vs. 55% at 13 years of follow-up (Log-rank, p<0.001). CR technique was also associated with better survival in PS adjusted cox regression (HR: 0.80, CI 95%: 0.68-0.95, p=0.010). In-hospital death (1%), prolonged mechanical ventilation time (>24h, 6%), length of hospital-stay ≥7days (53%), need of inotropic support (≥ 2 amines, 16%) and post-operative atrial fibrillation (19%) were similar between the 2 groups.</p> <p>Conclusion: In this long-term follow-up study, CR revealed to be a significant predictor of better prognosis considering all-causes of death, without impact in early postoperative results. Further randomized prospective studies are needed to provide recommendations on revascularization techniques.</p>
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