Detrimental effects of incomplete revascularization following CABG-multiple arterial grafting may not solve the problem

Abstract

The past 5 years has seen an increased emphasis on enhancing graft patency in order to improve long-term survival following Coronary Artery Bypass Graft (CABG) surgery. This includes the increased use of multiple arterial grafts; especially the use of the radial artery (RA), intraoperative transit time flow measurements to detect technical anastomotic issues, and optimization of storage solutions for saphenous vein grafts to enhance endothelial cell preservation. 1-4 In this issue of the Journal, Schwann et al 5 studied the effect of the completeness of revascularization on long term survival following CABG and whether multiple arterial grafting would have any impact on the outcomes. They analyzed 15 year mortality in 7157 CABG patients based on the completeness of revascularization. A completeness of revascularization index (CRI) was calculated based on the difference between the number of coronary grafts and the number of diseased coronary artery systems as reported in their institution's STS database.This resulted in three types of revascularization patterns: Incomplete, Complete, and two levels of Supra-Complete revascularization.Although the incidence of incomplete revascularization was only 4.5%, incomplete revascularization was associated with decreased late survival despite the use of multiple arterial grafting. Schwann et al