Concomitant CABG vs. CABG Alone - A Comparative Analysis of Early Outcomes
Concomitant CABG vs. CABG Alone
DOI:
https://doi.org/10.54393/pjhs.v4i09.986Keywords:
Coronary Artery Bypass Graft Surgery, Concomitant CABG, Mortality, OutcomesAbstract
Concomitant CABG is performed in combination with other cardiac procedures (VHD, CHD) while CABG is performed exclusively for CAD. Objective: To compare the mortality and perioperative outcomes between CABG and concomitant CABG for proper quoting of risk & optimizing the treatment decision for improved patient outcomes. Methods: The observational study on retrospective data was conducted at Rehman Medical Institute from December 2020 to December 2022. A total of 169 patients were included, with 89 in the CABG and 80 in the concomitant CABG group. Ethical approval was granted and inclusion criteria were met. Data were analyzed using SPSS 25. Results: A total of 169 patients were included with a mean age of 57.72±10.65 & the majority of the male population (77.5%). Most of the patients had NYHA III (56.1%) & CCS III (43.9%) class symptoms. Hypertension was our most common co-morbidity (58.0%), followed by dyslipidemia (52.3%) & DM (47.3%). Concomitant CABG has the worst parameters in terms of intraoperative characteristics such as a statistically significant higher rate of intraoperative transfusion (p <0.001), prolonged perfusion (p <0.001) & cross-clamp time (p<0.001). Similarly, concomitant CABG patients have the worst postoperative outcomes with a significantly higher incidence of mortality (p <0.001), post-operative transfusion requirement (p 0.008), increased duration of mechanical ventilation hours (p 0.005), extended hours of ICU stay (p 0.02) & higher rates of re-intubation (p 0.03). Conclusions: Concomitant CABG is no doubt a high-risk procedure as signified by its worst outcomes.
References
Saleem W, Iqbal F, Saleem F. Age Versus HBA1c: Which Is a Better Predictor of Acute Kidney Injury in Diabetics After CABG? Age versus HBA1c: Which is a better predictor of Acute Kidney Injury in Diabetics after CABG?. Pakistan Journal of Health Sciences. 2022 Oct; 3(5): 258-62. doi: 10.54393/pjhs.v3i05.272. DOI: https://doi.org/10.54393/pjhs.v3i05.272
Ch’ng SL, Cochrane AD, Wolfe R, Reid C, Smith CI, Smith JA. Procedure-specific cardiac surgeon volume associated with patient outcome following valve surgery, but not isolated CABG surgery. Heart, Lung and Circulation. 2015 Jun; 24(6): 583-9. doi: 10.1016/j.hlc.2014.11.014. DOI: https://doi.org/10.1016/j.hlc.2014.11.014
Hannan EL, Wu C, Bennett EV, Carlson RE, Culliford AT, Gold JP, et al. Risk index for predicting in-hospital mortality for cardiac valve surgery. The Annals of Thoracic Surgery. 2007 Mar; 83(3): 921-9. doi: 10.1016/j.athoracsur.2006.09.051. DOI: https://doi.org/10.1016/j.athoracsur.2006.09.051
Edwards FH, Peterson ED, Coombs LP, DeLong ER, Jamieson WE, Shroyer AL, et al. Prediction of operative mortality after valve replacement surgery. Journal of the American College of Cardiology. 2001 Mar; 37(3): 885-92. doi: 10.1016/S0735-1097(00)01202-X. DOI: https://doi.org/10.1016/S0735-1097(00)01202-X
Nowicki ER, Birkmeyer NJ, Weintraub RW, Leavitt BJ, Sanders JH, Dacey LJ, et al. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England. The Annals of Thoracic Surgery. 2004 Jun; 77(6): 1966-77. doi: 10.1016/j.athoracsur.2003.12.035. DOI: https://doi.org/10.1016/j.athoracsur.2003.12.035
Schroeter T, Lehmann S, Misfeld M, Borger M, Subramanian S, Mohr FW, et al. Clinical outcome after mitral valve surgery due to ischemic papillary muscle rupture. The Annals of Thoracic Surgery. 2013 Mar; 95(3): 820-4. doi: 10.1016/j.athoracsur.2012.10.050. DOI: https://doi.org/10.1016/j.athoracsur.2012.10.050
Rosborough D. Cardiac surgery in elderly patients: strategies to optimize outcomes. Critical Care Nurse. 2006 Oct; 26(5): 24-31. doi: 10.4037/ccn2006.26.5.24. DOI: https://doi.org/10.4037/ccn2006.26.5.24
Toumpoulis IK, Anagnostopoulos CE, Toumpoulis SK, DeRose Jr JJ, Swistel DG. EuroSCORE predicts long-term mortality after heart valve surgery. The Annals of Thoracic Surgery. 2005 Jun; 79(6): 1902-8. doi: 10.1016/j.athoracsur.2004.12.025. DOI: https://doi.org/10.1016/j.athoracsur.2004.12.025
Hansen LS, Hjortdal VE, Andreasen JJ, Mortensen PE, Jakobsen CJ. 30-day mortality after coronary artery bypass grafting and valve surgery has greatly improved over the last decade, but the 1-year mortality remains constant. Annals of Cardiac Anaesthesia. 2015 Apr; 18(2): 138. doi: 10.4103/0971-9784.154462. DOI: https://doi.org/10.4103/0971-9784.154462
Gardner SC, Grunwald GK, Rumsfeld JS, Cleveland Jr JC, Schooley LM, Gao D, et al. Comparison of short-term mortality risk factors for valve replacement versus coronary artery bypass graft surgery. The Annals of Thoracic Surgery. 2004 Feb; 77(2): 549-56. doi: 10.1016/S0003-4975(03)01585-6. DOI: https://doi.org/10.1016/S0003-4975(03)01585-6
Zare E, Soltani MH, Chenaghlou M, Hadadzadeh M, Mansouri M, Salehi R, et al. Survival rate of patients undergoing aortic, mitral, and tricuspid valve replacement with prosthetic valves. Cardiovascular Biomedicine Journal. 2021 Oct; 1(1): 40-5. doi: 10.18502/cbj.v1i1.7550. DOI: https://doi.org/10.18502/cbj.v1i1.7550
Goel K, Pack QR, Lahr B, Greason KL, Lopez-Jimenez F, Squires RW, et al. Cardiac rehabilitation is associated with reduced long-term mortality in patients undergoing combined heart valve and CABG surgery. European Journal of Preventive Cardiology. 2015 Feb; 22(2): 159-68. doi: 10.1177/2047487313512219. DOI: https://doi.org/10.1177/2047487313512219
Agarwal AK, Mch CT, Saurabh KS, Mch CT, Popli K. Short Term Outcomes of Coronary Artery Bypass Grafting and Concomitant Valve Procedure: A Retrospective Review. Journal of Medical Science and Clinical Research. 2019 Jul; 7(7 ): 196. doi: 10.18535/jmscr/v7i7.39. DOI: https://doi.org/10.18535/jmscr/v7i7.39
Birkmeyer NJ, Marrin CA, Morton JR, Leavitt BJ, Lahey SJ, Charlesworth DC, et al. Decreasing mortality for aortic and mitral valve surgery in Northern New England. The Annals of Thoracic Surgery. 2000 Aug; 70(2): 432-7. doi: 10.1016/S0003-4975(00)01456-9. DOI: https://doi.org/10.1016/S0003-4975(00)01456-9
Matyal R, Qureshi NQ, Mufarrih SH, Sharkey A, Bose R, Chu LM, et al. Update: Gender differences in CABG outcomes—Have we bridged the gap? PLoS One. 2021 Sep; 16(9): e0255170. doi: 10.1371/journal.pone.0255170. DOI: https://doi.org/10.1371/journal.pone.0255170
Ullah W, Gul S, Saleem S, Syed MA, Khan MZ, Zahid S, et al. Trend, predictors, and outcomes of combined mitral valve replacement and coronary artery bypass graft in patients with concomitant mitral valve and coronary artery disease: a National Inpatient Sample database analysis. European Heart Journal Open. 2022 Jan; 2(1): oeac002. doi: 10.1093/ehjopen/oeac002. DOI: https://doi.org/10.1093/ehjopen/oeac002
Davarpasand T, Hosseinsabet A, Jalali A. Concomitant coronary artery bypass graft and aortic and mitral valve replacement for rheumatic heart disease: short-and mid-term outcomes. Interactive Cardiovascular and Thoracic Surgery. 2015 Sep; 21(3): 322-8. doi: 10.1093/icvts/ivv132. DOI: https://doi.org/10.1093/icvts/ivv132
Gunay R, Sensoz Y, Kayacioglu I, Tuygun AK, Balci AY, Kisa U, et al. Is the aortic valve pathology type different for early and late mortality in concomitant aortic valve replacement and coronary artery bypass surgery? Interactive Cardiovascular and Thoracic Surgery. 2009 Oct; 9(4): 630-4. doi: 10.1510/icvts.2009.206078. DOI: https://doi.org/10.1510/icvts.2009.206078
LaPar DJ, Anvari F, Irvine Jr JN, Kern JA, Swenson BR, Kron IL, et al. The impact of coronary artery endarterectomy on outcomes during coronary artery bypass grafting. Journal of Cardiac Surgery. 2011 May; 26(3): 247-53. doi: 10.1111/j.1540-8191.2011.01247.x. DOI: https://doi.org/10.1111/j.1540-8191.2011.01247.x
LaPar DJ, Crosby IK, Rich JB, Fonner Jr E, Kron IL, Ailawadi G, et al. A contemporary cost analysis of postoperative morbidity after coronary artery bypass grafting with and without concomitant aortic valve replacement to improve patient quality and cost-effective care. The Annals of Thoracic Surgery. 2013 Nov; 96(5): 1621-7. doi: 10.1016/j.athoracsur.2013.05.050. DOI: https://doi.org/10.1016/j.athoracsur.2013.05.050
De Waard GA, Jansen EK, De Mulder M, Vonk AB, Umans VA. Long-term outcomes of isolated aortic valve replacement and concomitant AVR and coronary artery bypass grafting. Netherlands Heart Journal. 2012 Mar; 20: 110-7. doi: 10.1007/s12471-011-0238-6. DOI: https://doi.org/10.1007/s12471-011-0238-6
Gillinov AM and Garcia MJ. When is concomitant aortic valve replacement indicated in patients with mild to moderate stenosis undergoing coronary revascularization? Current Cardiology Reports. 2005 Mar; 7(2): 101-4. doi: 10.1007/s11886-005-0020-8. DOI: https://doi.org/10.1007/s11886-005-0020-8
Sa MP, Van den Eynde J, Cavalcanti LR, Kadyraliev B, Enginoev S, Zhigalov K, et al. Mitral valve repair with minimally invasive approaches vs sternotomy: A meta‐analysis of early and late results in randomized and matched observational studies. Journal of Cardiac Surgery. 2020 Sep; 35(9): 2307-23. doi: 10.3390/jcdd10030095. DOI: https://doi.org/10.1111/jocs.14799
Tüysüz ME and Dedemoğlu M. The Effectiveness of Heart Valve Replacement Surgery in a Non-Referral Regional Hospital: The Analysis of Outcomes after Isolated and Complex Valve Replacement. Heart Surgery Forum. 2019 Aug; 22(5): E343-E351. doi: 10.1532/hsf.2373. DOI: https://doi.org/10.1532/hsf.2373
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Pakistan Journal of Health Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments