Open Heart Surgery Best Practice Identified in National Medical Journal - MedQ
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Open Heart Surgery Best Practice Identified in National Medical Journal

The MedQuarter | June 11th, 2018

June 4, 2018 – Cardiothoracic surgeons with UnityPoint Health – Cedar Rapids Heart and Vascular Institute received confirmation of what they’ve suspected for years – their way of performing open heart surgery at St. Luke’s Hospital is considered best practice.

A report in The New England Journal of Medicine (NEJM) published May 31 concluded the use of radial-artery grafts may result in better long-term outcomes for patients than the use of saphenous-vein grafts.

Open heart surgery or coronary artery bypass graft surgery (CABG) is a surgical procedure performed to reduce the risk of death from heart disease. Arteries or veins from elsewhere in the patient’s body are grafted to the coronary arteries to bypass blockages or narrowing of the arteries and improve blood circulation to the heart.

“We started using radial grafts for open heart surgery whenever we can when it’s safe for the patient around January 2000,” said James Levett, MD, cardiothoracic surgeon, Physicians’ Clinic of Iowa, P.C. “We had seen evidence over the years that arteries tend to have a longer lifespan than veins because they had a better chance of remaining open and functioning well for many years.”

The NEJM report provides further evidence in the validity of this technique. It lists the results of its analysis of six trials, which study the use of arteries versus veins. The researcher notes the following findings; the incidence of adverse cardiac events was significantly lower, artery grafts resulted in a significantly lower risk of occlusion (closure), a slightly lower risk of a heart attack and a lower incidence of repeat revascularization was also noted. Additionally, the researcher found “the use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency (open) at 5 years of follow-up.”

The report notes the use of multiple arterial grafts has been recommended by current guidelines though the years but notes, “despite these recommendations, arterial grafts have not been widely adopted; in the United States, less than 10% of patients who undergo elective CABG receive more than one arterial graft, and a radial-artery graft is used in less than 7%.

“Seeing this research in The New England Journal of Medicine, a prestigious and highly respected medical publication, is satisfying to see,” said Dr. Levett. “As early adopters of the use radial grafts this research confirms St. Luke’s open heart team identifies best practice and does all it can to improve outcomes for our patients.”

According to Dr. Levett, St. Luke’s has a very high radial artery usage rate. About half of all open heart surgery patients at St. Luke’s have at least one radial artery placed in addition to an internal mammary graft.

This year St. Luke’s Hospital is celebrating 40 years of open heart surgery in Cedar Rapids. The first open heart surgery at St. Luke’s took place June 27, 1978. Since then there have been 13,454 open heart surgeries performed at St. Luke’s. The hospital has been nationally recognized six times as a Top 50 Heart Hospital.

 

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