Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the BYPASS Registry

Abstract

Introduction Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. Objective To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. Conclusion CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.

Valve Heart Surgery in Brazil – The BYPASS Registry Analysis

“…The majority of patients (80.8%) were operated through SUS, whereas 19.2% were covered by private payers. This finding is in consonance with an earlier report from the BYPASS Registry, where this current share does not reflect the present distribution of private and public patients in the Brazilian healthcare system, clearly overburdening the public sector (i.e., the SUS) [14] .…”

Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting: Structural Observations and Impact on Graft Performance

“…In a recent History of Medicine Perspective published in the New England Journal of Medicine, Jones DS [1] outlines the important contribution to coronary artery bypass grafting (CABG) made by Rene Favaloro, who first introduced the saphenous vein (SV) as a conduit for coronary revascularization [2] . In the subsequent 50 years, the SV has become the most commonly used graft in patients undergoing CABG [3,4] , yet its failure rate is greater than the one from the left internal thoracic artery (LITA) [5][6][7] . According to some, it is also inferior to that from the radial…”

Why Use the Radial Artery? The Saphenous Vein is the Second Graft of Choice for CABG in Brazi

“…A recent article in the Brazilian Journal of Cardiovascular Surgery described an analysis of the profile, risk factors, and outcomes of patients undergoing coronary artery bypass grafting (CABG) in Brazil [1] . As in other countries, the left internal thoracic artery (LITA) is the conduit of choice and used in 91% of the cases, with 5.6% of cases using the right internal thoracic artery (RITA).…”

“…As in other countries, the left internal thoracic artery (LITA) is the conduit of choice and used in 91% of the cases, with 5.6% of cases using the right internal thoracic artery (RITA). The second graft of choice in Brazil is the saphenous vein (SV), being used in 84.1% of the cases, with the radial artery (RA) being used in only 1.1% of cases (Paez et al [1] ). The SV was introduced as a bypass conduit by Favaloro, 50 years ago [2] .…”

“…While RA use in these patients declined, the use of SV remained fairly constant over the same time period. Clearly, the very recent data from the Brazilian BYPASS Registry shows that the preferred second conduit of choice for CABG in Brazil is SV [1] . Furthermore, many centres in Brazil use the no-touch (NT) technique of harvesting SV that was introduced over 20 years ago [10] , which provides a superior graft patency compared with conventional SV grafts at up to 16 years and is comparable to the LITA’s patency [11,12] .…”