VALIDATION AND INTERDEPENDENCE WITH PATIENT-VARIABLES OF THE INFLUENCE OF PROCEDURAL VARIABLES ON EARLY AND LATE SURVIVAL AFTER CABG

Objective: First to identify the patient-, procedural- and surgical ex perience variables influencing the early and late survival after CABG. Second to identify patients likely to benefit, and those unlikely to benefit, from technical details aimed at improving the results of coro nary artery bypass grafting (CABG). Methods: A consecutive series of 9 600 patients who underwent CABG using a variety of revascularization m ethods between 1971 and 1992 were followed with 99.9% success. A multi variable time-related analysis was performed. Patient-specific predict ions and nomograms were constructed from it to explore and validate th e influences and interdependences of patient-variables with variations in details of the procedure. Results: The 1-, 10- and 20-year risk-un adjusted survival was 97, 81 and 50% respectively. Patient-variables i nfluencing early survival included severity of symptoms, patient prese ntation and extent of coronary disease, while late survival was influe nced importantly by left ventricular function and cardiac and non-card iac comorbidity. Technical details of the operation influencing early survival included use of endarterectomy, while details such as use of arterial grafting, extensiveness of sequential grafting, completeness of revascularization and extent of grafting to small coronaries influe nced late survival to a highly variable degree. Conclusion: The early survival is neither improved nor worsened by single, multiple, sequent ial or complete arterial coronary reconstruction. The late survival is modestly improved with the use of an arterial graft to a major vessel , preferably but not exclusively to the anterior descendens, except fo r patients with limited life-expectancy. Differences in time-related s urvival with and without an arterial graft are nearly the same across all levels of ejection fraction. No late beneficial or detrimental eff ect was identified with more extensive use of arterial reconstructive surgery in multisystem disease. (C) 1997 Elsevier Science B.V.