From the Guidelines
The peri-operative mortality rate for CABG is between 1-4%, depending on the population studied. This rate is a critical consideration in the management of patients undergoing coronary artery bypass surgery, as it reflects the balance between the prognostic benefits of the procedure, such as reduced cardiac mortality, and the potential risks, including operative morbidity and mortality 1.
Factors Influencing Mortality Rate
Several factors can influence the peri-operative mortality rate for CABG, including:
- Patient age and comorbidities
- Surgical urgency and institutional experience
- The use of extra-corporeal circulation (cardiopulmonary bypass) versus off-pump surgery
- The type of grafts used, such as the left internal thoracic artery (LITA) or saphenous vein
Importance of Risk Stratification
Risk stratification models, such as those available for the assessment of risk in individual patients, are essential in determining the potential benefits and risks of CABG for each patient 1.
Recent Advances and Techniques
Recent advances in surgical techniques, anesthesia management, and perioperative care have contributed to a steady improvement in mortality rates over decades. However, the choice of surgical approach, including the use of off-pump surgery, should be made cautiously and selectively, taking into account the individual patient's characteristics and needs 1.
From the Research
Peri-operative Mortality Rate for CABG
- The peri-operative mortality rate for CABG varies across different studies, with reported rates ranging from 1.87% to 2.9% 2, 3.
- A study analyzing data from 34,416 patients found an operative mortality rate of 1.87% 2.
- Another study comparing patients aged 75 years or older with those younger than 75 years found an overall peri-operative mortality rate of 2.9% for the younger group and 2.7% for the older group 3.
- The use of preoperative intra-aortic balloon pump (IABP) support in high-risk patients has been shown to decrease the risk of morbidity and mortality, with an absolute risk reduction for mortality of 4.4% 4.
- A meta-analysis of 9,212 patients found that prophylactic IABP use before CABG surgery decreased the risk for mortality, myocardial infarction, cerebrovascular accident, and renal failure 4.
Factors Affecting Peri-operative Mortality Rate
- Patient risk factors, such as hypertension, hyperlipidemia, diabetes mellitus, and smoking, can affect the peri-operative mortality rate 3.
- The number of vessels involved and pre-operative left ventricular function can also impact the mortality rate 3.
- Emergency operations and re-operative CABG can increase the peri-operative mortality rate 3.
- The use of IABP support has been shown to be beneficial in high-risk patients, particularly those with a higher risk of mortality 5, 6, 4.