Long term outcomes after CABG in patients with severe extensive coronary artery calcinosis

Introduction. Extensive distal coronary artery calcinosis (CAC) limits myocardial revascularization and is associated with suboptimal outcomes of surgical treatment. Coronary artery bypass grafting (CABG) for CAC requires the use of complex coronary reconstructions (CCR), including coronary endarterectomy (CEE), prolonged angioplasty and anastomoses with arteries less than 1.5 mm. Worldwide data on long term outcomes after CABG in patients with CAC are limited. The purpose of the study. To analyze and compare long term outcomes after CABG in patients with and without distal CACMaterials and methods of research. A single-center retrospective study was performed, including 610 patients who underwent isolated CABG in the period from 2017-2019, of which 121 patients had CCA confirmed by computed tomography (CT), the rest - without CCA. After propensity score matching 115 pairs of patients were matched. Long-term outcomes were analyzed; the following events were studied as an end point: recurrence of angina and death. Median follow-up was 56 months (51, 62).Treatment results. The majority of patients were male (68,0 % vs. 67,6%, p=0,953), mean age was 66,1±8,6 and 65,7±7,9 years for the groups, respectively, p=0,708. The revascularization index was higher in group 1 (4,0±0,8 versus 3,7±0,7, p=0,002. In the CCA group, significantly more CCR was performed (43,3 % versus 24,5 %, p=0,005). The time of cardiopulmonary bypass (CPB) was also higher in the group with CCA (93,9±25,9 minutes versus 82,9±18,7 minutes, p=0,002). In the long-term period, the rate of angina recurrence was 27,8 % in the CCA group and 22,5 % in the group without CCA (p=0,280), mortality - 6,2 % versus 2,9 % (p=0,322)Conclusion. Extensive distal CCA is characterized by a higher frequency of CCR and duration of surgical treatment. CABG can be performed with complete myocardial revascularization and similar effectiveness in patients with and without CCA.