Outcome in Salvage Coronary Artery Bypass Grafting, a Multicenter Registry

Objectives: Salvage coronary artery bypass grafting (CABG) is often performed for cardiogenic shock on compassionate basis without clinical data justifying this aggressive approach. The aim of this study was to analyze early and intermediate outcomes after salvage CABG.

Methods: We retrospectively reviewed the data of 85 patients who underwent salvage CABG at 11 European cardiac surgery centers. Salvage CABG was defined according to the EuroSCORE criteria, i.e., a procedure performed in patients requiring cardiopulmonary resuscitation (external cardiac massage) en route to the operating theater or before induction of anesthesia.

Results: Thirty patients (35.3%) died during the in-hospital stay. The mean EuroSCORE II was 32.0 ±  % and the observed-to-expected ratio was 1.08. Salvage CABG was associated with high rates of postoperative stroke (9.4%), resternotomy for bleeding (23.5%), resternotomy for hemodynamic instability (15.3%), dialysis (18.8%), severe gastrointestinal complications (12.9%) and deep sternal wound infection (10.6%). Survival at 1-, 3- and 5- years was 58.6%, 49.8% and 40.9%, respectively.

Twenty patients (23.5%) were treated with extracorporeal membrane oxygenation (ECMO) postoperatively. The rates of adverse events after ECMO were particularly high (stroke 40%, resternotomy for bleeding 60%, dialysis 35%, gastrointestinal complications 30% and deep sternal wound infection 30%). Among patients treated with ECMO, eight (40%) survived to discharge and 1-year survival was 29.2%.

Conclusions: Salvage CABG is associated with high risk of immediate mortality and severe adverse events. However, the observed immediate and intermediate outcome justify coronary surgery in these critically ill patients. Several these patients are currently treated by ECMO additionally as ultima ratio and results are encouraging.