The trajectory of Coronary-Artery-Bypass-Grafting patient phenotype through 23 years

Abstract

Abstract Background Over 6 decades since the first Coronary-Artery-Bypass-Grafting (CABG) and it is considered as the most common cardiac surgery with established benefits on mortality and morbidity. Purpose Following the well-recognized epidemiology of coronary disease, we attempted to capture the difference over time on parameters such as baseline clinical profile, comorbidities, operation characteristics, short-term complications and perioperative mortality. Methods In this retrospective study, all adults patients with isolated CABG were included. The study period was from January 1st, 1997 until December 31, 2019. The statistical analysis referred to the prespecified time-points (the first and the last enrolled patient). Results 14235 consecutively patients underwent isolated CABG during the study period. We reported the trajectory of their baseline clinical, operative and periprocedural outcome's phenotype for 23 years. In this way we captured the current holistic profile of the CABG-patient as a timelapse (Table 1). Amongst baseline comorbidities we highlight the 40% increase of hypertension. Regarding the surgery parameters the increase in total and cross clamping time likely attests to the increasing difficulty in performing grafting in more diffusely diseased coronary vessels plus the time-forfeit of the increased usage of non-saphenous vein grafts. Notwithstanding, the perioperative mortality did not significantly change over time. Cardiac and neurological complications also remained the same, whereas renal and pulmonary complications rose. A possible explanation is the worsen baseline profile of the patients and the prolongation of operative duration. Conclusion Over time, more complicated patients are entering the operation room with increased age, decreased ejection fraction (EF) and additive comorbidities. Nota bene the perioperative mortality did not change over time, despite the worsen clinical profile and the accretion of technical difficulties which are expressed via the increased cross clamp time and the establishment of arterial grafting. Arterial grafting could be the behoof parameter that attenuated the mortality trend. To our knowledge this is one of the largest series on isolated CABG and probably the lone with extended duration beyond two decades. Funding Acknowledgement Type of funding sources: None.