Coronary Artery Bypass Grafting (CABG): Reassessing Efficacy, Safety, and Cost

David K. Cundiff

In This Article

Other CABG Risks

Between 5% and 15% of patients having CABG sustain intraoperative Q-wave AMI.[47,53,58,59] Patients with a perioperative myocardial infarction had an increased hospital mortality (about 10% to 15%) compared with about 1% for patients undergoing CABG who do not sustain a perioperative myocardial infarction.[60] Perioperative AMIs have also been associated with about double the risk of subsequent cardiac events, including death, in the year following surgery.[61] About two thirds of the postoperative mortality is caused by pump failure, and about one third is due to malignant ventricular tachyarrhythmias.[60]

Multifactorial coagulation abnormalities occurred postoperatively in CABG patients, often requiring considerable amounts of blood products to control the bleeding. Even with optimal medical management, about 5% of patients needed to return to the operating room for control of bleeding.[59]

Viral infections due to perioperative transfusions for CABG-related bleeding included cytomegalovirus, hepatitis B and C, and rarely HIV. A postoperative sternal infection leading to mediastinitis occurred in about 2% of cases overall and much more often in patients receiving bilateral internal mammary artery grafts.[62,63,64] The mortality of mediastinitis varied between 10% and 25%.[65,66] Cellulitis at the site of saphenous vein harvesting has recurred months or years later.[67]

Clinical or subclinical deep venous thrombosis happened in about a third to half of patients undergoing CABG. Approximately 0.5% of patients had clinically important pulmonary emboli, about a third of which were fatal.[68]

A variety of gastrointestinal complications following CABG, many requiring surgery, had a mortality of 1-1.5/1000.[69,70] Renal failure occurred postoperatively in 4.9% of CABG, with about 2% requiring dialysis. Post-CABG renal failure patients suffered a markedly increased mortality.[71,72,73] About 10% of patients after CABG had central nervous system complications, including stroke, visual disturbances, depression, and decreased cognitive function.[74,75,76]


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