Multiple Arterial Grafts Improve Late Survival of Patients Undergoing Coronary Artery Bypass Graft Surgery

Abstract

Background— Use of the left internal mammary artery (LIMA) in multivessel coronary artery disease improves survival after coronary artery bypass graft surgery; however, the survival benefit of multiple arterial (MultArt) grafts is debated. Methods and Results— We reviewed 8622 Mayo Clinic patients who had isolated primary coronary artery bypass graft surgery for multivessel coronary artery disease from 1993 to 2009. Patients were stratified by number of arterial grafts into the LIMA plus saphenous veins (LIMA/SV) group (n=7435) or the MultArt group (n=1187). Propensity score analysis matched 1153 patients. Operative mortality was 0.8% (n=10) in the MultArt and 2.1% (n=154) in the LIMA/SV ( P =0.005) group, which was not statistically different ( P =0.996) in multivariate analysis or the propensity-matched analysis ( P =0.818). Late survival was greater for MultArt versus LIMA/SV (10- and 15-year survival rates were 84% and 71% versus 61% and 36%, respectively [ P <0.001], in unmatched groups and 83% and 70% versus 80% and 60%, respectively [ P =0.0025], in matched groups). MultArt subgroups with bilateral internal mammary artery/SV (n=589) and bilateral internal mammary artery only (n=271) had improved 15-year survival (86% and 76%; 82% and 75% at 10 and 15 years [ P <0.001]), and patients with bilateral internal mammary artery/radial artery (n=147) and LIMA/radial artery (n=169) had greater 10-year survival (84% and 78%; P <0.001) versus LIMA/SV. In multivariate analysis, MultArt grafts remained a strong independent predictor of survival (hazard ratio, 0.79; 95% confidence interval, 0.66–0.94; P =0.007). Conclusions— In patients undergoing isolated coronary artery bypass graft surgery with LIMA to left anterior descending artery, arterial grafting of the non–left anterior descending vessels conferred a survival advantage at 15 years compared with SV grafting. It is still unproven whether these results apply to higher-risk subgroups of patients.

Are three arteries better than two? Impact of using the radial artery in addition to bilateral internal thoracic artery grafting on long-term survival

“…Moreover, the relatively small sample size can partially account for lack of survival benefit by using the RA. However, the non-significant trend towards lower survival probabilities in the BITA+RA group, also reported by others [4,5] limits the potential role of type beta error in rejecting the hypothesis of the superiority of the RA. Finally, the study was observational on prospectively collected data and selection bias cannot be excluded despite propensity score adjustment.…”

“…The right internal thoracic artery (RITA) has been advocated to further improve long term revascularization outcomes [2]. Whether the use of the radial artery (RA) [3][4][5] as third arterial conduit in addition to bilateral internal thoracic artery (BITA) grafting is associated with better survival when compared to BITA plus saphenous vein (SV) remains to be determined with isolated small series reporting conflicting results [6,7].…”

Coronary artery bypass grafting in diabetic patients: Should we still use the saphenous vein graft? A review of literature in the past 15 years

“…This study has the limitation of a 30 days post-intervention follow up and the finding of an higher rate of wound infection is not reported in other propensity matched studies [2,22,24,25].…”

“…LITA and RITA have been used as peduncolated or skeletonized graft, with direct anastomosis on the target vessels or in composite grafts (Y graft), used to perform the revascularization of a single coronary branch or more coronary branches [19,21] [2,[19][20][21][22].…”

Evaluation of Coronary Artery Bypass by CT Coronary Angiography

“…Reports on diagnostic accuracy of MDCT in CABG have shown values of sensitivity and specificity over 95% for the presence of lesions in these vessels. However, the investigation of native vessels showed that sensitivity and specificity are significantly lower than in patients with suspected coronary artery disease [14][15][16][17][18].…”