Current trends in routine myocardial revascularization

Abstract

Highlights. A 12-year experience of myocardial revascularization at the Research Institute of Complex Issues of Cardiovascular Diseases is reported. An increase in the number of patients with comorbidities resulted in more complex surgeries. Perioperative mortality and complication rates are consistent with the reported global data.Aim. To assess the temporal changes in baseline characteristics of patients with coronary artery disease (CAD), the range of surgical interventions, and the structure of significant in-hospital complications following coronary artery bypass grafting (CABG).Methods. 9,043 patients who underwent CABG between 2006 and 2018 were identified from a prospective CABG registry. 1,847 (20.4%) were women (the mean age of 63.11±7.4 years) and 7,196 (79.6%) were men (the mean age of 59.0±7.9 years). The main parameters on the underlying cardiovascular disease and comorbidities, the prevalence and extent of non-cardiac atherosclerosis, the type of CABG, and the volume of associated surgical interventions as well as the structure of perioperative complications were included in the statistical analysis.Results. We determined several trends characterizing the temporal changes in the clinical, morphological, and functional status of patients. The number of women undergoing CABG has increased 2.7-fold. The mean age of patients undergoing CABG has increased by 7.3 years. Patients are present with higher rates of comorbidities, including AF, diabetes (a 2.5-fold increase), hypertension (a 12% increase), as well as severe BCA stenoses (a 2.7-fold increase), a positive history of stroke, or TIA (a 2.1-fold increase). The number of combined surgical procedures during CABG has increased by 2.9. The prevalence of perioperative neurological and hemorrhagic complications requiring revision surgery, and deep wound infection have increased 4.3-fold. Waiting time for elective CABG has significantly reduced. The number of patients with a history of myocardial infarction (a 14.5% decrease) and severe peripheral artery disease has decreased. In-hospital mortality has decreased over the past decade.Conclusion. Over the past decade, the number of patients with comorbidities who require more complex surgeries has increased at the Research Institute for Complex Issues of Cardiovascular Diseases. Perioperative mortality tends to decrease. However, an increase in the number of neurological, hemorrhagic, and infectious perioperative complications requires the initiation of new preventive measures.