Related Experiment Video
Updated: Aug 29, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Composite arterial grafts versus conventional grafting for coronary artery bypass grafting
J F Légaré1, K J Buth, J A Sullivan
1Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Composite arterial grafts for coronary artery bypass grafting may increase patient morbidity despite similar mortality rates compared to conventional methods. Further research is needed to assess the overall safety and efficacy of these grafts.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Composite arterial grafts offer complete arterial revascularization in coronary artery bypass grafting (CABG) surgery.
- A limitation is the inflow from a single internal thoracic artery supplying all grafted vessels.
Purpose of the Study:
- To review the safety of composite arterial grafts.
- To compare outcomes of grafts using bilateral internal thoracic arteries or single internal thoracic artery with radial artery.
Main Methods:
- Retrospective analysis of 402 patients receiving composite grafts versus 542 controls.
- Propensity score matching and multivariate analysis were used.
- Outcomes included death, intra-aortic balloon pump use, myocardial infarction, stroke, and prolonged ventilation.
Main Results:
- Matched groups (n=249 each) showed similar in-hospital mortality (1.2% vs 0.4%).
- Composite grafts had longer pump and clamp times, and increased prolonged mechanical ventilation (12.8% vs 4.8%).
- Composite arterial grafting independently predicted combined morbidity (OR 2.1).
Conclusions:
- Composite arterial grafting may increase risk-adjusted patient morbidity compared to conventional CABG.
- A demonstrable mortality difference was not found between the groups.
Objectives:
Composite arterial grafts for coronary artery bypass grafting surgery allow complete arterial revascularization but are limited by the inflow of a single internal thoracic artery supplying all the grafted vessels. We reviewed the safety of composite arterial grafts using either bilateral internal thoracic arteries or a single internal thoracic artery and radial artery.
Methods:
From January 1999 to July 2002, 402 consecutive patients receiving composite grafts only were compared to a control group of patients (n = 542) undergoing coronary artery bypass grafting with internal thoracic artery and saphenous veins operated upon by the same surgeons. Two different statistical approaches were used to compare groups in this retrospective analysis. First, propensity score analysis with greedy matching technique was used to match patients from each group. Second, a multivariate analysis was performed looking at a combined patient outcome of death, intra-aortic balloon counterpulsation utilization, myocardial infarction, stroke, and prolonged ventilation on all patients in both groups.
Results:
After matching by propensity score, the major clinical outcomes in composite arterial (n = 249) and control (n = 249) groups were found to be similar. The in-hospital mortality in the composite group was 1.2% as compared with 0.4% in matched patients (P =.62). However, patients in the composite group were found to have a significantly longer pump time (P <.0001), longer clamp time (P <.0001), increased incidence of prolonged mechanical ventilation (12.8% vs 4.8%; P =.002), and higher incidence of combined morbidity outcome (13.6% vs 6.4%; P =.007) as compared with matched patients. Multivariable analysis showed that composite arterial grafting was an independent predictor of the combined morbidity outcome with an odds ratio of 2.1 (1.2-3.7).
Conclusions:
These findings suggest that composite arterial grafting may be associated with an increase in risk-adjusted patient morbidity when compared with a conventional coronary artery bypass grafting group, although a mortality difference was not demonstrable.
