Abstract 742: Does Incomplete Surgical Revascularization Affect Early Or Long-term Outcome In Patients With Multi-vessel Disease Receiving Left Internal Mammary Artery To Left Anterior Descending Artery Bypass?
Objectives: To evaluate the impact of incomplete (IR) vs. complete revascularization (CR) in others than LAD territory in patients presenting prognostic relevant coronary artery disease (CAD).
Methods: During a 7 year period 10.218 consecutive patients with 3-CAD, 2-CAD including the proximal LAD or left main stem stenosis underwent sternotomy for isolated CABG including LIMA-LAD bypass. Total 1.175 (11.5%) had IR of the Cx or RCA territory. IR was considered when not performing at least one bypass to a significant diseased primary arterial territory (functional classification). Follow-up was 3.1±2.2 years.
Results: Pts. were comparable in age (IR 67.6 vs. CR 66.7y) and EF (56.1 vs. 65.4%). LogEuroscore was higher for IR pts. (5.7 vs. 4.9%, p=0.001). 22.9% were OPCAB procedures. Distal anastomoses were mean 2.4±0.9 (IR) vs. 3.0±0.9 (CR). Operation time (186 vs. 171 min) and #-clamp time (54 vs. 48 min) were significantly longer in IR (each p<0.001). Hospital mortality was 3.1% (IR) vs. 3.9% (CR). Independent risk factors were emergency indication (odds ratio OR 6.4, p=0.002), logEuroScore >10% (OR 4.3, p=0.01) but not IR. Cumulative 1-year-survival was 91.3% (IR) vs. 92.0% (CR) and 78.4 (IR) vs. 81.0% (CR) at 5-year follow-up (log rank p=0.047). Multivariate analysis identified diabetes (OR 2.1) and logEuroSCORE >10% (OR 4.5) as the only independent risk factors for cumulative mortality.
Conclusions: IR at the Cx or RCA territory did not adversely affect early outcome. However, IR was an univariate risk factor for cumulative mortality that demonstrated more likely a surrogate for higher comorbidities.