CABG practice in the Netherlands 2005 – 2020:More arterial grafting, stable pump use, good outcomes

The abstract format is a 7-slide presentation, which is attached to this record.• 2018 ESC/EACTS guidelines recommend total arterial grafting for high-grade coronary artery stenosis• Reduction of off-pump CABG practice shown in the Society of Thoracic Surgeons Adult Cardiac Surgery Database• Publications with added benefit of radial artery grow, yet confounders remain• What are the trends, and outcomes of Coronary Artery Bypass Grafting in the Netherlands in 2005-2020 based on a nationwide quality registry?• Aim 1: Trends in contemporary CABG practice in the Netherlands in 2005-2020• Aim 2: Outcomes in contemporary CABG practice in the Netherlands 2014-2020</div

Trends and Outcomes of Coronary Artery Bypass Grafting in the Netherlands 2005 – 2020: A Netherlands Heart Registration Registry-based Study

Purpose: The aim is to describe trends of isolated coronary artery bypass grafting (CABG) practice in the Netherlands from 2005-2020, with 30-day major adverse cardiac and cerebrovascular events (MACCE) and 5-year survival and freedom from coronary reintervention for 2014-2020. Methods: Adult patients receiving isolated CABG between 2005 – 2020 and registered in Netherlands Heart Registration were included. Trends in off-pump (OPCABG), on-pump CABG (ONCABG), and type of graft were analysed with linear regression. Casemix corrected 30-day MACCE (mortality, revascularisation, perioperative myocardial infarction, stroke) was analysed with logistic regression, and 5-year endpoints with Kaplan-Meier and Cox regression. Results: No decrease in OPCABG (14% in 2005, 17% in 2020), p = 0.29, and an increase in total arterial CABG (17% in 2005, 28% in 2020, p = 0.001) with dominant practice for ONCABG with mixed grafting (65%) were found (n=120000). MACCE increased for venous ONCABG (p &lt; 0.001), was reduced for arterial ONCABG (p = 0.002), mixed and venous OPCABG (p &lt; 0.001 and p = 0.02), and not significantly reduced for arterial OPCABG (p = 0.23), n=49775. Longest 5-year survival times were for ONCABG with arterial grafting (95%), and shortest for ONCABG with venous grafting (78%), a significant difference between all CABG subtypes (p &lt; 0.001). A significant increase in revascularisation was observed for all but arterial ONCABG (p = 0.09). Conclusion: This is the first study to analyse Dutch national CABG practice. ONCABG total arterial grafting showed consistent good outcomes, but might be biased by OPCABG practice differences and missing data.</div

The evaluation of the aortic annulus displacement during cardiac cycle using magnetic resonance imaging

Abstract Background The stress in the ascending aorta results from many biomechanical factors including the geometry of the vessel and its maximum dimensions, arterial blood pressure and longitudinal systolic stretching due to heart motion. The stretching of the ascending aorta resulting from the longitudinal displacement of the aortic annulus during the heart cycle has not been examined in the general population so far. The aim of the study is to evaluate this parameter using cardiovascular magnetic resonance (CMR) imaging in the general population in all age groups. Methods The cardiac magnetic resonance images of 73 patients were evaluated. The maximum distance to which the ventriculo-aortic junction was pulled by the contracting heart (LDAA – longitudinal displacement of the aortic annulus) was measured in the cine coronal sequences. Moreover, the maximum dimensions of the aortic root and the ascending aorta were assessed. Results The LDAA value was on average 11.6 ± 2.9 mm (range: 3-19 mm; 95% CI: 10.9–12.3 mm) and did not differ between males and females (11.8 ± 2.9 mm vs. 11.2 ± 2.9 mm, p = .408). The diameter of the ascending aorta was 32 ± 6.3 mm (range: 20-57 mm). The maximal dimension of the aortic root was 35 ± 5.1 mm (range: 18-42 mm). There was a statistically significant negative correlation between the LDAA and the age of patients (r = −.38, p = .001). There was no significant correlation between the LDAA and aortic root dimension (r = .1, p = .409) and between the LDAA and diameter of the ascending aorta (r = .16, p = .170). Conclusions Human aortic root and ascending aorta are significantly stretched during systole and the distance to which the aorta is stretched decreases with age. The measurement of the longitudinal displacement of the aortic annulus using the CMR is feasible and reproducible

The combined impact of mechanical factors on the wall stress of the human ascending aorta – a finite elements study

Abstract Background Biomechanical factors influence stress in the aortic wall. The aim of this study was to assess how the diameter and shape of the vessel, blood pressure and longitudinal systolic aortic stretching (SAS) caused by the contraction of the myocardium influence stress in the aortic wall. Methods Three computational models of the non-dilated aorta and aneurysms of the ascending aorta and aortic root were created. Then, finite elements analyses were carried out. The models were subjected to blood pressure (120 mmHg and 160 mmHg) and longitudinal systolic aortic stretching (0 mm, 5 mm, 10 mm and 15 mm). The influence of wall elasticity was examined too. Results Blood pressure had a smaller impact on the stress than the SAS. An increase in blood pressure from 120 mmHg to 160 mmHg increased the peak wall stress (PWS) on average by 0.1 MPa in all models. A 5 mm SAS caused a 0.1–0.2 MPa increase in PWS in all the models. The increase in PWS caused by a 10 mm and 15 mm SAS was 0.2 MPa and 0.4 MPa in the non-dilated aorta, 0.2–0.3 MPa and 0.3–0.5 MPa in the aneurysm of the ascending aorta, and 0.1–0.2 MPa and 0.2–0.3 MPa in the aortic root aneurysm model, respectively. The loss of elasticity of the aneurysmal wall resulted in an increase of PWS by 0.1–0.2 MPa. Conclusions Aortic geometry, wall stiffness, blood pressure and SAS have an impact on PWS. However, SAS had the biggest impact on wall stress. The results of this study may be useful in future patient-specific computational models used to assess the risk of aortic complications