One-year results of total arterial revascularization vs. conventional coronary surgery: CARRPO trial
Sune Damgaard1, Jørn Wetterslev, Jens T Lund
1Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. sunedamgaard@dadlnet.dk
Insights
Total arterial revascularization (TAR) in coronary surgery is as safe and effective as conventional revascularization (CR) within one year. Further studies will determine if TAR offers superior long-term benefits for broader clinical use.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary artery disease necessitates surgical revascularization.
- Total arterial revascularization (TAR) utilizes both internal thoracic and radial arteries.
- Conventional revascularization (CR) typically employs the internal thoracic artery and vein grafts.
Purpose of the Study:
- To compare clinical and angiographic outcomes of TAR versus CR in patients with multivessel or isolated left main coronary artery disease.
Main Methods:
- A randomized trial involving 331 patients comparing TAR with CR.
- Primary outcome: patency index (patent grafts/total grafts) at one-year angiography.
- Secondary outcomes: graft patency rates and major adverse cardiac events.
Main Results:
- One-year angiography showed similar mean patency indices: 87% (TAR) vs. 88% (CR).
- Graft patency was high in both groups: 72% (TAR) vs. 67% (CR) with all grafts patent.
- One-year cardiac event rates were comparable: 23% (TAR) vs. 25% (CR).
Conclusions:
- Total arterial revascularization (TAR) demonstrates comparable safety and efficacy to conventional revascularization (CR) within one year post-surgery.
- Long-term follow-up is needed to ascertain sustained benefits or superiority of TAR.
Aims:
To investigate clinical and angiographic outcomes after coronary surgery using total arterial revascularization (TAR).
Methods And Results:
We randomized 331 patients with multivessel or isolated left main disease to TAR [internal thoracic (ITA) and radial arteries] vs. conventional revascularization (CR) using left ITA and vein grafts. The primary angiographic outcome was the patency index: number of patent grafts (<50% stenosed) divided by number of constructed grafts. One-year angiography was complete for 83% of patients. Mean patency index (+/-SD) was 87 +/- 22% in the TAR group and 88 +/- 18% in the conventional group (P = 0.52). In 72% of TAR patients and 67% of the conventional group, all grafts were patent (P = 0.45). Multiple imputation of missing angiographic data did not influence on results. Within 1 year, 37 (23%) TAR patients and 43 (25%) conventional group patients suffered cardiac events (HR 1.09, 95% CI 0.70-1.69, P = 0.70). One patient (0.6%) in the TAR group and two (1.2%) in the conventional group died (P = 1.00).
Conclusion:
Within 1 year post-operatively, TAR seems at least as safe and effective as CR. Prolonged follow-up will reveal whether this is sustained or superior results of TAR can justify a more general use.
