2022 Coronary Artery Disease Results

Podcast Transcript

Announcer:

Welcome to Cleveland Clinic Cardiac Consult, brought to you by Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute at Cleveland Clinic.

Faisal Bakaeen, MD:

Good morning. Thank you, Lars and Marc, for the privilege of presenting the CABG for this last year. High volume, high complexity, and high-quality characterized CABG at the Cleveland Clinic. Our volumes have gone up steadily over the last three years. That is bucking national trends. We've done more than 1,000 isolated CABG cases last year. CABG, as an isolated procedure or combined procedure, accounts for a third of all adult cardiac cases at the Clinic. We do the complexity, the entire gamut of it, from minimally invasive to low EF in collaboration with our Heart Failure colleagues, from poor targets that are turned down elsewhere, to complex reoperations, and we do more reoperations than anybody else in the world. I'll come back to that later.

The isolated CABG mortality is something to be proud of. Patients are three times less likely to die after CABG at the Cleveland Clinic than elsewhere. Not only do they survive, but they survive with less complications. For example, they are less likely to have a complication of renal failure or dialysis, and the risk of getting external wound infection is virtually zero. That is why we achieved the top ranking, the three-star ranking of the STS. Our competitors struggle to do so. Not only are the short-term outcomes excellent, but we concentrate on the lifelong care of patients and long-term outcomes. So, we use multi arterial grafting more than elsewhere, and that's associated with improved survival. Every important target, as a default approach, gets an arterial conduit.

This is only possible because of the team. I've talked about that during prior presentations, but this team is world-class. This team cares, this team innovates. An example of that is the picture in the top right corner. This is Ryan Carter, improvising in a very difficult situation, a redo CABG with lack of conduit using the mammary retractor to lift up the leg and harvest the lesser saphenous vein.

So, we owe it to ourselves and our patients to stay at the cutting edge, and our research helps us do so and it's impactful. Multiple publications, the Clinic is involved in steering and leadership committees of ongoing major CABG trials. And as I mentioned before, our high volume and complexity allows us to do research that's impossible, impossible elsewhere. For example, we're looking at over 11,000 redo CABG operations to investigate the impact of multi arterial grafting. This sneak preview is unadjusted, so don't go spreading it, but this gives you a flavor of the kind of stuff we do here.

Our work gets attention. The Cleveland Clinic work got featured in the covers of two major cardiovascular journals last year, the Annals and the Seminars of Cardiothoracic Surgery. The Clinic is involved in all major ongoing coronary guidelines and when CABG was downgraded in 2021, the Clinic came out strong to demonstrate gaps and misinterpretations of the evidence to reaffirm CABG as a standard of care in patients with complex three vessel coronary disease based on scientific facts. Over the last 50 years, beginning with Dr. Favaloro and Sones, the cardiologists and the surgeons have worked closely together to give the best possible care for our patients. Our patients get the best care, our patients get the best outcomes. Thank you very much.

Announcer:

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