Impact of acute coronary graft failure and subsequent urgent endovascular revascularization after planned coronary artery bypass grafting on hospital outcome

Abstract

Highlights The authors conducted a comparative analysis of early postoperative complications, mortality and economic costs in patients who underwent additional urgent endovascular revascularization and patients with standard postoperative period.There are statistically significant differences between the groups in terms of the number of resternotomies performed, the need for transfusable blood components and economic costs.It is necessary to introduce routine intraoperative quality control of the intervention, and a set of measures aimed at early detection of coronary graft failure in real clinical practice. Abstract Aim. To assess the impact of coronary graft failure and subsequent urgent endovascular revascularization in the early postoperative period after elective coronary artery bypass grafting on hospital outcome.Materials and methods. 8801 patients underwent isolated coronary artery bypass grafting at the Federal State Budgetary Institution “Federal Center for Cardiovascular Surgery” of the Ministry of Health of the Russian Federation in Chelyabinsk from 2011 to 2020. Inclusion criteria were as follows: patients with stable coronary heart disease, patients undergoing elective coronary artery bypass grafting. Exclusion criteria were as follows: patients with unstable angina and acute myocardial infarction who underwent urgent revascularization. The primary endpoint was hospital mortality, secondary endpoints are bleeding requiring resternotomy, acute abdominal and infectious complications, and multiple organ failure. Due to suspected acute myocardial injury, 196 (2.23%) patients underwent urgent coronary angiography, and according to angiogram, additional endovascular correction was performed in 60 (0.68%) patients (the group I). To assess the impact of coronary graft failure and subsequent revascularization on hospital outcome we have analyzed: hospital mortality, complications in the early postoperative period, financial costs. Moreover, we have formed the group II of 60 people with uncomplicated postoperative period for comparative analysis.Results. Of 196 (2.23%) patients who underwent urgent angiography 60 (0.68%) patients required stenting of native coronary arteries or conduits due to coronary graft failure. Hospital mortality in the group with complicated postoperative period was 10 % (6 cases), hemorrhagic complications occurred in 13 (21.7%) patients, acute abdomen was noted in 4 patients, and sternal wound infection was noted in 5 patients, hemodialysis due to multiple organ failure was performed in 5 patients. An intergroup comparative analysis revealed a clear trend towards an increase in deaths in the group I (n = 6/10%) compared to the group II (n = 1/1.7%), however, there were no significant differences (p = 0.11F). Hemorrhagic complications occurred significantly higher in group I (13/21.7% versus 1/1.7%, p = 0.001F); there were no statistically significant differences associated with the other complications. The number of bed-days spent in the hospital and in the intensive care unit was statistically significantly higher in the group I, financial costs per patient were also significantly higher in the group I.Conclusion. Coronary bypass graft failure in the early postoperative period leads to an increase in hospital mortality, in the frequency of multiple organ failure and hemorrhagic complications, and significantly increases the amount of needed economic resources.