Choice of conduit for coronary artery bypass grafting in poor ventricles
Saina Attaran1, Matthew Shaw, Hesham Z Saleh
1Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK. saina.attaran@kcl.ac.uk
Insights
This study compared arterial and vein grafts for coronary artery bypass grafting in patients with poor heart function. Outcomes were similar across graft types, indicating high mortality regardless of conduit choice.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Graft Patency and Survival
Background:
- Arterial grafts offer advantages in coronary artery revascularization.
- Patients with severely impaired ventricular function (ejection fraction < 30%) present unique challenges in cardiac surgery.
Purpose of the Study:
- To compare the outcomes and survival rates of different graft conduits in patients undergoing coronary artery bypass grafting with ejection fraction < 30%.
Main Methods:
- A 10-year study of 979 patients with ejection fraction < 30% undergoing isolated, first-time coronary artery bypass grafting.
- Patients were divided into three groups: total arterial grafts (n=257), total vein grafts (n=76), and left internal mammary artery plus vein grafts (n=610).
- Multivariate logistic regression was used to adjust for patient and disease characteristics, comparing hospital and 5-year survival rates.
Main Results:
- Hospital mortality rates were 8.9% (arterial), 11.8% (vein), and 5.7% (arterial/vein).
- Five-year mortality rates were 27.2% (arterial), 42.3% (vein), and 28.7% (arterial/vein).
- After risk adjustment, no significant differences in hospital or long-term mortality were found among the groups.
Conclusions:
- Patients with poor ventricular function face high short- and long-term mortality regardless of the graft conduit used.
- Mortality rates were comparable between total arterial grafts and combined arterial/vein grafts, both before and after risk adjustment.
Background:
advantages in the use of arterial grafts for coronary artery revascularizations have been reported previously.
Objectives:
we aimed to compare the outcome and survival rates of different conduits in patients with poor ventricular function (ejection fraction<30%).
Methods:
in a 10-year period, 979 patients with an ejection fraction<30%, who underwent isolated first-time coronary artery bypass grafting, were divided into in 3 groups: (A) total arterial grafts (n=257), (B) total vein grafts (n=76), and (C) left internal mammary artery and vein grafts (n=610). Multivariate logistic regression was used to assess the effect of graft type on mortality, while adjusting for patient and disease characteristics. Hospital mortality and 5-year survival rates were compared among the groups.
Results:
hospital mortality was 8.9% for group A, 11.8% for group B, and 5.7% for group C. Mortality at 5 years was 27.2% for group A, 42.3% for group B, and 28.7% for group C. After risk adjustment, hospital mortality and mid- and long-term mortality showed no significant differences among the groups.
Conclusions:
patients with poor ventricular function have a high mortality rate in both the short- and long-term with any type of conduit. Mortality rates with total arterial grafts and vein plus arterial grafts were comparable before and after risk adjustment.
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