Outcomes Of Isolated Coronary Artery Bypass In Peripheral Artery Disease Patients

Abstract: OBJECTIVE: We carried out a propensity-score based analysis on early outcomes after coronary artery bypass grafting (CABG) in patients with or without peripheral vascular disease (PAD). METHODS: Eighteen thousand-three hundred-eleven patients undergoing isolated CABG between 1997 and 2017 were included into the study. Subjects with previous or concomitant vascular surgery were excluded. The main endpoints were death, stroke and limb ischemia requiring percutaneous or surgical revascularization. Sub-Group analyses were carried out to test the interaction of PAD with concomitant factors. RESULTS: The incidence of death was comparable in patients with or without PAD (p=0.06 and p=0.179, respectively). In contrast, PAD patients showed a higher incidence of stroke (p=0.04) acute kidney disease (p=0.003) and limb ischemia requiring intervention (p<0.001).The employment of off-pump or no-touch aortic techniques did not influence the effect of PAD on outcomes (all, p>0.05). In contrast, early mortality increased with PAD when the arteriopathy was associated to long CPB and CC times (both p<0.001) and postoperative low output syndrome (p=0.01). CONCLUSIONS: The presence of peripheral arterial disease increases independently of other factors the incidence of postoperative stroke, acute kidney disease and limb ischemia irrespective of the technique employed.In contrast, death was higher in PAD patients only when it was associated to postoperative low output syndrome, long cardiopulmonary bypass and aortic cross clamp times.