Re-Sternotomy Coronary Artery Bypass 1999-2018: Insights from the STS Adult Cardiac Surgery Database

ABSTRACT

BACKGROUND

We sought to quantify the risk trend of re-sternotomy coronary artery bypass grafting (CABG)over the past two decades.

METHODS

We compared the outcomes of 194,804 consecutive re-sternotomy CABG cases and 1,445,894 randomly-selected first-time CABG cases (50% of total) reported to the STS Adult Cardiac Surgery Database between 1999-2018. Primary outcomes were in-hospital mortality and overall morbidity. Using multiple logistic regression for each outcome for each year, we computed the annual trends of risk-adjusted odds-ratios for the primary outcomes in the entire cohort and in 194,776 propensity-matched pairs.

RESULTS

Annual participating center`s re-sternotomy CABG case volume declined by 68% (from a median of 25 {range 14-44} to a median of 8 {4-15}). Compared with first-time CABG, re-sternotomy CABG patients were consistently older with higher proportions of co-morbidities. After propensity matching, primary outcomes of re-sternotomy and first-time CABG were similar (mortality: 3.5% vs. 2.3%, Standardized Difference {SD}=7.5%, morbidity: 40.7% vs. 40.3%, SD=0.9%). Mortality of re-sternotomy CABG performed after prior CABG was higher than that after prior non-CABG (4.3% vs. 2.4%, SD=10.8). Morbidity was similar between these subgroups (41.0% vs. 39.1%, SD=2.9). The adjusted odds ratio for mortality after re-sternotomy CABG declined from 1.93 (95% CI 1.73-2.16) to 1.22 (95% CI 0.92-1.62), and that of morbidity from 1.13 (95% CI 1.08-1.18) to 0.91 (95% CI 0.87-0.95), p<0.001 for both.

CONCLUSIONS

The risk of re-sternotomy CABG has decreased substantially over time. Re-sternotomy CABG performed after a prior CABG is higher risk compared to that performed after a non-CABG operation.