International Society For Minimally Invasive Cardiothoracic Surgery

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Long-term Outcomes Of Coronary Artery Bypass Grafting In Veterans With Ischemic Cardiomyopathy
Kyongjune B. Lee1, Sheena Chen1, Andrew Sparks1, Richard Amdur1, Gregory D. Trachiotis2.
1George Washington University, Washington, DC, USA, 2Washington D.C. VA Medical Center, Washington, DC, USA.

OBJECTIVE: Surgical Treatment for Ischemic Heart Failure (STICH) trial, has shown that surgical revascularization of patients with ischemic cardiomyopathy (ICM) significantly improves mortality and rates of hospitalization over ten years. The objective of this study is to evaluate how well the veterans with ICM undergoing revascularization perform against their counterpart without ICM and examine how the findings in the civilian population translate in the veteran population. METHODS: This is a retrospective review of a prospectively maintained single-center database. From 2000 to 2018, 1461 patients underwent isolated coronary artery bypass grafting (CABG). There were 201 patients with ejection fraction less than 35% who were classified as ICM cohort. The primary outcome was mortality. Secondary outcomes included significant postoperative complications. Subgroup analysis was performed within the ICM cohort to compare the outcomes of off versus on-pump CABG.RESULTS: Patients in the ICM and the non-ICM group had similar demographic profiles. ICM group was more likely to have a history of myocardial infarction, diabetes, chronic kidney disease, and higher rates of preoperative intra-aortic balloon pump use. The non-ICM cohort was more functionally independent. Surgeries were performed off-pump in 80.1% and 66.3% of ICM and non-ICM cohorts respectively. Unadjusted mortality was higher for ICM cohort at 30 days (5% vs 2.1%), 1 year (12.9% vs 4.6%), 5 years (31.8% vs 18.2%), and at 10 years (36.3% vs 22.2%). Subsequent multivariable regression model analysis showed there was no statistical difference between ICM and non-ICM cohort in 30-day mortality (OR 1.94 [0.79-4.75]). However, ICM cohort had increased all-cause mortality (OR 1.75 [1.14-2.67]). The subgroup analysis of ICM cohort showed that there was a strong trend of improved short-term mortality with Off-pump CABG (3.1% vs. 12.5%, OR 0.31 [0.05-1.82]), though it was not statistically significant.CONCLUSIONS: Veterans with ICM undergoing CABG demonstrated comparable short-term survival compared to non-ICM veterans. However, the long-term survival in ICM cohort is still inferior to patients without ICM. There is a strong trend of improved short-term survival in patients with ICM undergoing off-pump CABG.

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