Coronary artery bypass surgery prognosis

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Coronary Artery Bypass Surgery Microchapters

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Patient Information

Overview

Pathophysiology

Saphenous Vein Graft Disease
Other Non-Atherosclerotic Saphenous Vein Graft Diseases

Indications for CABG

Prognosis

Diagnosis

Imaging in the Patient Undergoing CABG

Chest X Ray

Angiography

CT Angiography
MRI Angiography

Trans-Esophageal Echocardiography

Treatment

Goals of Treatment

Perioperative Management

Perioperative Monitoring

Electrocardiographic Monitoring
Pulmonary Artery Catheterization
Central Nervous System Monitoring

Surgical Procedure

Anesthetic Considerations
Intervention in left main coronary artery disease
The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)
Minimally Invasive CABG
Hybrid coronary revascularization
Conduits Used for Bypass
Videos on Spahenous Vein Graft Harvesting
Videos on Coronary Artery Bypass Surgery

Post-Operative Care and Complications

Pharmacotherapy in patients undergoing CABG CABG

Special Scenarios

Anomalous Coronary Arteries
COPD/Respiratory Insufficiency
Existing Renal Disease
Concomitant Valvular Disease
Previous Cardiac Surgery
Menopause
Carotid Disease evaluation before surgery

Coronary artery bypass surgery prognosis On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Mohammed A. Sbeih, M.D. [3] Anahita Deylamsalehi, M.D.[4]

Overview

Prognosis following Coronary artery bypass surgery (CABG) depends on a variety of factors. In general, CABG improves the chances of survival of patients who are at high risks, such as those patients with the left main disease. After approximately 5 years the difference in survival rate between those who have had surgery and those treated by medication therapy diminishes. Age at the time of CABG is critical to the prognosis, therefore younger patients with no complicating diseases have a high probability of greater longevity. Recommended by ACC 2021 guideline, STS score system can be used to predict adverse outcomes of CABG such as death, renal failure, prolonged hospital stay, and mediastinitis.

Prognosis

Age

  • Age at the time of CABG is critical factor to determine the prognosis. Younger patients with no complicating diseases have a high probability of greater longevity.
  • In a cohort study of 1,388 patients who were 48.9 years in average at the time of their first surgery survival rate were as follows:
    • 5 years: 93.6%
    • 10 years: 81.1%
    • 15 years: 62.1%
    • 20 years: 46.7%
    • 23 years: 38.4%

Society of Thoracic Surgery (STS) Risk Score


Adverse Outcomes CABG CABG and heart value surgery
Mortality rate 0.804 0.761
Permanent stroke 0.697 0.632
Renal failure 0.826 0.759
Prolonged mechanical ventilation 0.772 0.744
Repeated surgery 0.621 0.588
Composite morbidity and mortality 0.738 0.712
Prolonged post operation hospitalization 0.777 0.739
Deep sternal wound infection/Mediastinitis 0.681 0.659

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[3]

Public Reporting of Cardiac Surgery Outcomes (DO NOT EDIT)[3]

Class I
"1. Public reporting of cardiac surgery outcomes should use risk-adjusted results based on clinical data.[4][5][6][7][8][9][10][11] (Level of Evidence: B)"

Use of Outcomes or Volume as CABG Quality Measures (DO NOT EDIT)[3]

Class I
"1. All cardiac surgery programs should participate in a state, regional, or national clinical data registry and should receive periodic reports of their risk-adjusted outcomes. (Level of Evidence: C)"
Class IIa
"1. When credible risk-adjusted outcomes data are not available, volume can be useful as a structural metric of CABG quality.[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Level of Evidence: B)"
Class IIb
"1. Affiliation with a high-volume tertiary center might be considered by cardiac surgery programs that perform fewer than 125 CABG procedures annually. (Level of Evidence: C)"

References

  1. 1.0 1.1 1.2 1.3 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).
  2. O'Brien SM, Feng L, He X, Xian Y, Jacobs JP, Badhwar V; et al. (2018). "The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 2-Statistical Methods and Results". Ann Thorac Surg. 105 (5): 1419–1428. doi:10.1016/j.athoracsur.2018.03.003. PMID 29577924.
  3. 3.0 3.1 3.2 Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
  4. Geraci JM, Johnson ML, Gordon HS, Petersen NJ, Shroyer AL, Grover FL; et al. (2005). "Mortality after cardiac bypass surgery: prediction from administrative versus clinical data". Med Care. 43 (2): 149–58. PMID 15655428.
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  9. Mack MJ, Herbert M, Prince S, Dewey TM, Magee MJ, Edgerton JR (2005). "Does reporting of coronary artery bypass grafting from administrative databases accurately reflect actual clinical outcomes?". J Thorac Cardiovasc Surg. 129 (6): 1309–17. doi:10.1016/j.jtcvs.2004.10.036. PMID 15942571.
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  12. Clark RE (1996). "Outcome as a function of annual coronary artery bypass graft volume. The Ad Hoc Committee on Cardiac Surgery Credentialing of The Society of Thoracic Surgeons". Ann Thorac Surg. 61 (1): 21–6. PMID 8561556.
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  14. Hannan EL, Kilburn H, Bernard H, O'Donnell JF, Lukacik G, Shields EP (1991). "Coronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors". Med Care. 29 (11): 1094–107. PMID 1943270.
  15. Hannan EL, Siu AL, Kumar D, Kilburn H, Chassin MR (1995). "The decline in coronary artery bypass graft surgery mortality in New York State. The role of surgeon volume". JAMA. 273 (3): 209–13. PMID 7807659.
  16. Hannan EL, Wu C, Ryan TJ, Bennett E, Culliford AT, Gold JP; et al. (2003). "Do hospitals and surgeons with higher coronary artery bypass graft surgery volumes still have lower risk-adjusted mortality rates?". Circulation. 108 (7): 795–801. doi:10.1161/01.CIR.0000084551.52010.3B. PMID 12885743.
  17. Kalant N, Shrier I (2004). "Volume and outcome of coronary artery bypass graft surgery: are more and less the same?". Can J Cardiol. 20 (1): 81–6. PMID 14968146.
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  19. Peterson ED, Coombs LP, DeLong ER, Haan CK, Ferguson TB (2004). "Procedural volume as a marker of quality for CABG surgery". JAMA. 291 (2): 195–201. doi:10.1001/jama.291.2.195. PMID 14722145.
  20. Rathore SS, Epstein AJ, Volpp KG, Krumholz HM (2004). "Hospital coronary artery bypass graft surgery volume and patient mortality, 1998-2000". Ann Surg. 239 (1): 110–7. doi:10.1097/01.sla.0000103066.22732.b8. PMC 1356200. PMID 14685108.
  21. Shahian DM, O'Brien SM, Normand SL, Peterson ED, Edwards FH (2010). "Association of hospital coronary artery bypass volume with processes of care, mortality, morbidity, and the Society of Thoracic Surgeons composite quality score". J Thorac Cardiovasc Surg. 139 (2): 273–82. doi:10.1016/j.jtcvs.2009.09.007. PMID 20022608.
  22. Showstack JA, Rosenfeld KE, Garnick DW, Luft HS, Schaffarzick RW, Fowles J (1987). "Association of volume with outcome of coronary artery bypass graft surgery. Scheduled vs nonscheduled operations". JAMA. 257 (6): 785–9. PMID 3492614.
  23. Shroyer AL, Marshall G, Warner BA, Johnson RR, Guo W, Grover FL; et al. (1996). "No continuous relationship between Veterans Affairs hospital coronary artery bypass grafting surgical volume and operative mortality". Ann Thorac Surg. 61 (1): 17–20. doi:10.1016/0003-4975(95)00830-6. PMID 8561546.
  24. Sowden AJ, Deeks JJ, Sheldon TA (1995). "Volume and outcome in coronary artery bypass graft surgery: true association or artefact?". BMJ. 311 (6998): 151–5. PMC 2550219. PMID 7613425.
  25. Welke KF, Barnett MJ, Sarrazin MS, Rosenthal GE (2005). "Limitations of hospital volume as a measure of quality of care for coronary artery bypass graft surgery". Ann Thorac Surg. 80 (6): 2114–9. doi:10.1016/j.athoracsur.2005.05.017. PMID 16305854.
  26. Wu C, Hannan EL, Ryan TJ, Bennett E, Culliford AT, Gold JP; et al. (2004). "Is the impact of hospital and surgeon volumes on the in-hospital mortality rate for coronary artery bypass graft surgery limited to patients at high risk?". Circulation. 110 (7): 784–9. doi:10.1161/01.CIR.0000138744.13516.B5. PMID 15302792.

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