Operative and Late Results of Conventional CABG.
10.4326/jjcvs.28.87
- VernacularTitle:ｃｏｎｖｅｎｔｉｏｎａｌ ＣＡＢＧの手術成績と遠隔期成績
- Author:
Kenji Takazawa
;
Taira Yamamoto
;
Yasuyuki Hosoda
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
1999;28(2):87-93
- CountryJapan
- Language:Japanese
-
Abstract:
This study reviewed the operative results in patients who underwent elective isolated coronary artery bypass grafting (CABG) from 1991 to 1997 and the long-term outcome in patients who received an internal thoracic artery (ITA) to left anterior descending artery graft from 1984 to 1995. The morbidity rates were as follows: low output syndrome (LOS), 19 (2.6%); perioperative myocardial infarction (PMI), 14 (1.9%); IABP required, 9 (1.2%); respiratory insufficiency, 32 (4.4%); acute renal failure, 28 (3.8%); mediastinitis, 9 (1.2%); stroke, 13 (1.8%); and reoperation for bleeding, 9 (1.2%). Operative mortality was 0.7%. Patients with moderate or severe impairment of left ventricular function (ejection fraction≤40) or chronic renal failure had high incidences of arrthythmia and respiratory insufficiency; those who were 75 or older at operation had a higher incidence of arrhythmia than those who were 50 or under (p=0.033). Patients who received four or five grafts needed a longer duration of hospitalization than those who received a single graft (p=0.0147). The 10-year actuarial survival rate, cardiac death-free rate and cardiac event-free rate in the entire series were 89.4%, 96.7%, and 80.9%, respectively. Among patients who underwent complete revascularization, the 10-year cardiac event-free rate and catheter intervention-free rate were 82.7% and 91.7%, respectively, compared with 77.5% and 84.2% in patients who underwent incomplete revascularization (p=0.0428, 0.0343). Since this study demonstrated that CABG with cardiopulmonary bypass contributed to favorable operative and long-term results, the indications for minimally invasive direct coronary artery bypass (MIDCAB) and off-pump CABG should be considered carefully and perhaps limited to elderly patients and/or those with major co-morbidities, until the long-term benefits have been clarified.
