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Complete surgical revascularization: different definitions, same impact?
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  • Paulo Oliveira,
  • Márcio Madeira,
  • Sara Ranchordas,
  • Marta Marques,
  • Manuel Almeida,
  • Miguel Sousa-Uva ,
  • Miguel Abecasis,
  • José Neves
Paulo Oliveira
Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz
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Márcio Madeira
Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz
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Sara Ranchordas
Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz
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Marta Marques
Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz
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Manuel Almeida
Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz
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Miguel Sousa-Uva
Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz
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Miguel Abecasis
Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz
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José Neves
Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz
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Abstract

Abstract Objectives: There are several different definitions of complete revascularization on coronary surgery across the literature. Despite the importance of this definition there is no agreement on which one has the most impact. The aim of this study was to evaluate which definition of complete surgical revascularization correlates with early and late outcomes. Methods: All consecutive patients submitted to isolated CABG from 2012 to 2016 with previous myocardial scintigraphy were evaluated. Exclusion criteria: emergent procedures and previous cardiac surgery procedures. Population of 162 patients, follow-up complete in 100% patients; median 5,5 IQR 4,4-6,9 years. Each and all of the 162 patients were classified as complying or not with the four different definitions: Numerical, Functional, Anatomical Conditional and Anatomical unconditional. Univariable and multivariable analyses were developed to detect if any definition was a predictor of perioperative and long-term outcomes. Results: Complete functional revascularization was a predictor of increased survival (HR 0.47 CI95: 0,226-0,969; p=0.041). No other definitions showed effect on follow-up mortality. Age and cardiac dysfunction increased long-term mortality. The definition of complete revascularization did not have an impact on MACCE or need for revascularization Conclusions: An uniformly accepted definition of complete coronary revascularization is lacking. This research raises awareness about the importance of viability guidance for CABG.

Peer review status:ACCEPTED

14 Mar 2021Submitted to Journal of Cardiac Surgery
15 Mar 2021Submission Checks Completed
15 Mar 2021Assigned to Editor
22 May 2021Reviewer(s) Assigned
25 May 2021Review(s) Completed, Editorial Evaluation Pending
25 May 2021Editorial Decision: Revise Major
22 Jul 20211st Revision Received
23 Jul 2021Assigned to Editor
23 Jul 2021Submission Checks Completed
25 Jul 2021Reviewer(s) Assigned
28 Jul 2021Review(s) Completed, Editorial Evaluation Pending
28 Jul 2021Editorial Decision: Revise Minor
19 Aug 20212nd Revision Received
20 Aug 2021Submission Checks Completed
20 Aug 2021Assigned to Editor
20 Aug 2021Reviewer(s) Assigned
21 Aug 2021Review(s) Completed, Editorial Evaluation Pending
21 Aug 2021Editorial Decision: Accept