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Impact of arterial revascularization in patients undergoing coronary bypass
Giuseppe Nasso1, Georges Popoff, Mauro Lamarra
1Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy. gnasso@libero.it
Insights
Using two arterial conduits in coronary bypass surgery significantly improves long-term outcomes compared to one. This strategy offers better freedom from cardiac death and adverse events for multivessel coronary disease patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Arterial Grafting
Background:
- Ongoing debate regarding optimal revascularization strategies for multivessel coronary disease.
- Myocardial revascularization with arterial conduits is a key area of investigation.
Purpose of the Study:
- To analyze the long-term results of myocardial revascularization using arterial conduits.
- Compare different arterial grafting strategies in coronary bypass surgery.
Main Methods:
- Retrospective review of 10,752 patients undergoing coronary bypass surgery.
- Propensity-matched analysis of three groups based on revascularization strategy: one vs. two vs. total arterial grafts.
- Average follow-up of 37.2 months.
Main Results:
- Overall operative mortality was 2.8%, with patient factors predicting mortality.
- No significant difference in operative mortality among groups.
- Patients receiving more than one arterial conduit showed better long-term freedom from cardiac death and adverse events.
- Use of only one arterial conduit, diabetes, and depressed LVEF predicted cardiac mortality and adverse events.
Conclusions:
- Strong evidence supports the use of two arterial conduits over one for improved long-term outcomes.
- Arterial conduits in coronary surgery yield optimal operative and late results.
- These results serve as a benchmark for percutaneous intervention comparisons.
Background And Aim:
A debate over alternative therapeutic strategies for multivessel coronary disease is currently ongoing. We aimed at analyzing the results of myocardial revascularization with arterial conduits.
Methods:
We retrospectively reviewed 10,752 patients undergoing isolated coronary bypass surgery within our hospital's group. Average follow-up was 37.2 months. Through propensity-matching, we generated three groups (3584 patients each) on the basis of the revascularization strategy: use of one mammary artery plus venous grafts, use of two mammary arteries plus venous graft, and total arterial revascularization.
Results:
Overall operative mortality was 2.8%. Patient-related factors (renal failure, advanced age, recent myocardial infarction, depressed LVEF, diabetes) were identified as predictors of mortality (logistic regression). Although mortality was not statistically different among groups, patients receiving more than one arterial conduit displayed in the long-term better freedom from cardiac death and from adverse cardiac events (repeat revascularization, myocardial infarction, recurrent angina) (Kaplan-Meier analysis). Use of only one arterial conduit, diabetes and depressed LVEF predicted cardiac mortality, and adverse events (Cox regression). No differences in any endpoint emerged among patients receiving two arterial conduit plus venous grafts or total arterial revascularization.
Conclusions:
These data strongly support the practice of using two arterial conduits rather than one. The operative and late results of coronary surgery with arterial conduits are optimal and should serve as a current benchmark for the comparison with state-of-the-art percutaneous interventions.
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