Alistair Royse1,2, Zulfayandi Pawanis1,3, David Canty1,2, Jared Ou-Young1, David Eccleston4, Andrew Ajani4, Christopher M Reid5,6, Rinaldo Bellomo7,8,9, Colin Royse1,10. 1. Department of Surgery, The University of Melbourne, Melbourne, Australia. 2. Department of Cardiothoracic surgery, The Royal Melbourne Hospital, Melbourne, Australia. 3. Department of Surgery, Universitas Airlangga Hospital, Airlangga Health Science Institute, Universitas Airlangga, Surabaya, Indonesia. 4. Department of Medicine and Cardiology, The University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia. 5. Department of Epidemiology, School of Preventive Medicine, Curtin University, Perth, Australia. 6. Department of Epidemiology, School of Public Health, Monash University, Melbourne, Australia. 7. Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia. 8. Department of Intensive Care, Austin Health, Melbourne, Australia. 9. Department of Intensive Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia. 10. Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia.
Abstract
OBJECTIVES: Saphenous vein graft (SVG) remains the predominant conduit used in coronary surgery. The internal mammary artery has higher later term patency and confers superior survival. Current debate focuses on the increased use of arterial conduits rather than eradication of venous conduits. METHODS: Patient data extracted from the Australian and New Zealand Society of Cardiothoracic Surgeons database from 2001-2013 were linked to the national death registry held by the Australian Institute of Health and Welfare for all-cause mortality with censor date 7 October 2014. The dataset was divided according to use of SVG rather than the arterial conduit. Analyses of SVG ≥ 1 or SVG = 1 were compared to SVG = 0. Additionally, groups of 3, 4 or 5 grafts were subjected to multiple analyses testing the mortality hazard with increasing use of SVG. Propensity score matched analyses were conducted using 24 variables. RESULTS: Of 51 113 primary coronary surgery patients, unmatched survival at up to 12.5 years was significantly lower for SVG ≥ 1, n = 33 359, mortality hazard ratio (HR) 1.24 [95% confidence interval (CI) 1.18-1.30], P < 0.001; and for SVG = 1, mortality HR 1.19 (95% CI 1.12-1.26), P < 0.001. Similar results were present for the propensity score matched groups; SVG ≥ 1, n = 14 355 pairs, HR 1.22 (95% CI 1.15-1.30), P < 0.001; and for SVG = 1, n = 12 316 pairs, HR 1.22 (95% CI 1.14-1.30), P < 0.001. All matched analyses within restricted graft groups had increasing HR with increased number of SVG used. CONCLUSIONS: Any use of SVGs is independently associated with reduced survival after coronary artery bypass surgery.
OBJECTIVES: Saphenous vein graft (SVG) remains the predominant conduit used in coronary surgery. The internal mammary artery has higher later term patency and confers superior survival. Current debate focuses on the increased use of arterial conduits rather than eradication of venous conduits. METHODS:Patient data extracted from the Australian and New Zealand Society of Cardiothoracic Surgeons database from 2001-2013 were linked to the national death registry held by the Australian Institute of Health and Welfare for all-cause mortality with censor date 7 October 2014. The dataset was divided according to use of SVG rather than the arterial conduit. Analyses of SVG ≥ 1 or SVG = 1 were compared to SVG = 0. Additionally, groups of 3, 4 or 5 grafts were subjected to multiple analyses testing the mortality hazard with increasing use of SVG. Propensity score matched analyses were conducted using 24 variables. RESULTS: Of 51 113 primary coronary surgery patients, unmatched survival at up to 12.5 years was significantly lower for SVG ≥ 1, n = 33 359, mortality hazard ratio (HR) 1.24 [95% confidence interval (CI) 1.18-1.30], P < 0.001; and for SVG = 1, mortality HR 1.19 (95% CI 1.12-1.26), P < 0.001. Similar results were present for the propensity score matched groups; SVG ≥ 1, n = 14 355 pairs, HR 1.22 (95% CI 1.15-1.30), P < 0.001; and for SVG = 1, n = 12 316 pairs, HR 1.22 (95% CI 1.14-1.30), P < 0.001. All matched analyses within restricted graft groups had increasing HR with increased number of SVG used. CONCLUSIONS: Any use of SVGs is independently associated with reduced survival after coronary artery bypass surgery.
Authors: Kaspar M Trocha; Peter Kip; Ming Tao; Michael R MacArthur; J Humberto Treviño-Villarreal; Alban Longchamp; Wendy Toussaint; Bart N Lambrecht; Margreet R de Vries; Paul H A Quax; James R Mitchell; C Keith Ozaki Journal: Cardiovasc Res Date: 2020-02-01 Impact factor: 10.787