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    The effect on survival from the use of a saphenous vein graft during coronary bypass surgery: a large cohort study

    Access Status
    Fulltext not available
    Authors
    Royse, A.
    Pawanis, Z.
    Canty, D.
    Ou-Young, J.
    Eccleston, D.
    Ajani, A.
    Reid, Christopher
    Bellomo, R.
    Royse, C.
    Date
    2018
    Type
    Journal Article
    
    Metadata
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    Citation
    Royse, A. and Pawanis, Z. and Canty, D. and Ou-Young, J. and Eccleston, D. and Ajani, A. and Reid, C. et al. 2018. The effect on survival from the use of a saphenous vein graft during coronary bypass surgery: a large cohort study. European Journal of Cardio-Thoracic Surgery: Official Journal of the European Association for Cardio-Thoracic Surgery. 54 (6): pp. 1093-1100.
    Source Title
    European Journal of Cardio-Thoracic Surgery: Official Journal of the European Association for Cardio-Thoracic Surgery
    DOI
    10.1093/ejcts/ezy213
    ISSN
    1873-734X
    School
    School of Public Health
    URI
    http://hdl.handle.net/20.500.11937/74509
    Collection
    • Curtin Research Publications
    Abstract

    OBJECTIVES: Saphenous vein graft (SVG) remains the predominant conduit used in coronary surgery. The internal mammary artery has higher later term patency and confers superior survival. Current debate focuses on the increased use of arterial conduits rather than eradication of venous conduits. METHODS: Patient data extracted from the Australian and New Zealand Society of Cardiothoracic Surgeons database from 2001–2013 were linked to the national death registry held by the Australian Institute of Health and Welfare for all-cause mortality with censor date 7 October 2014. The dataset was divided according to use of SVG rather than the arterial conduit. Analyses of SVG ≥ 1 or SVG = 1 were compared to SVG = 0. Additionally, groups of 3, 4 or 5 grafts were subjected to multiple analyses testing the mortality hazard with increasing use of SVG. Propensity score matched analyses were conducted using 24 variables. RESULTS: Of 51 113 primary coronary surgery patients, unmatched survival at up to 12.5 years was significantly lower for SVG ≥ 1, n = 33 359, mortality hazard ratio (HR) 1.24 [95% confidence interval (CI) 1.18–1.30], P < 0.001; and for SVG = 1, mortality HR 1.19 (95% CI 1.12–1.26), P < 0.001. Similar results were present for the propensity score matched groups; SVG ≥ 1, n = 14 355 pairs, HR 1.22 (95% CI 1.15–1.30), P < 0.001; and for SVG = 1, n = 12 316 pairs, HR 1.22 (95% CI 1.14–1.30), P < 0.001. All matched analyses within restricted graft groups had increasing HR with increased number of SVG used. CONCLUSIONS: Any use of SVGs is independently associated with reduced survival after coronary artery bypass surgery.

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