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Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study
Ariane Drouin1, Nicolas Noiseux, Carl Chartrand-Lefebvre
1Division of Cardiac Surgery, 3840, Saint-Urbain Street, Montreal, Quebec, H2W 1T8, Canada. lm.stevens@umontreal.ca.
Insights
A new composite coronary artery bypass grafting (CABG) strategy using a venous bridge may extend the benefits of left internal mammary artery (LIMA) grafts. This approach aims for non-inferior graft patency compared to conventional CABG techniques.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Myocardial Revascularization
Background:
- Coronary artery bypass grafting (CABG) is crucial for severe coronary artery disease.
- Bypass graft patency is key to CABG effectiveness for symptom relief and mortality reduction.
- Left internal mammary artery (LIMA) to left anterior descending (LAD) anastomosis offers superior graft patency.
Purpose of the Study:
- To evaluate a novel composite grafting strategy for CABG.
- To assess if this strategy achieves non-inferior anterolateral graft patency compared to conventional methods.
- To explore potential benefits like easier technique and reduced aortic manipulation.
Main Methods:
- A randomized non-inferiority trial involving 200 patients undergoing primary isolated CABG.
- Comparison between a new composite LIMA-saphenous vein graft strategy and conventional LIMA-to-LAD with separate aorto-coronary vein grafts.
- Primary outcome: anterolateral graft patency index at one year via computed tomography angiography; 10-year clinical follow-up.
Main Results:
- Primary outcome data on graft patency index at one year is pending.
- Long-term clinical outcomes including mortality and myocardial infarction will be assessed over ten years.
- The trial is registered on ClinicalTrials.gov (NCT01585285).
Conclusions:
- The composite grafting strategy shows potential to enhance CABG outcomes.
- This innovative approach may offer advantages in graft patency and surgical technique.
- The trial's findings could significantly advance adult cardiac surgery practices.
Background:
In severe coronary artery disease, coronary artery bypass grafting (CABG) surgery is indicated to re-establish an adequate blood supply to the ischemic myocardium. Effectiveness of CABG surgery for symptom relief and mortality decrease should therefore depend on bypass graft patency. As bypass using a left internal mammary artery (LIMA)-to-left anterior descending coronary artery (LAD) anastomosis allows the best results in terms of graft patency, we designed a new surgical technique using a saphenous vein graft as a venous bridge to distribute the LIMA flow to the cardiac anterolateral territory. This novel strategy could extend the patency benefits associated to the LIMA. Other potential benefits of this technique include easier surgical technique, possibility to use saphenous vein grafts as vein patch angioplasty, shorter saphenous vein grafts requirement and reduced or eliminated manipulations of the ascendant aorta (and associated stroke risk).
Methods/Design:
Between July 2012 and 2016, 200 patients undergoing a primary isolated CABG surgery using cardiopulmonary bypass with a LAD bypass graft and at least another target on the anterolateral territory will be randomized (1:1) according to 1) the new composite strategy and 2) the conventional strategy with a LIMA-to-LAD anastomosis and revascularization of the other anterolateral target(s) with a separated aorto-coronary saphenous vein graft. The primary objective of the trial is to assess whether the composite strategy allows non-inferior anterolateral graft patency index (proportion of non-occluded CABGs out of the total number of CABGs) compared to the conventional technique. The primary outcome is the anterolateral graft patency index, evaluated at one year by 256-slice computed tomography angiography. Ten years of clinical follow-up is planned to assess clinical outcomes including death, myocardial infarction and need for revascularization.
Discussion:
This non-inferiority trial has the potential to advance the adult cardiac surgery field, given the potential benefits associated with the composite grafting strategy.
Trial Registration:
ClinicalTrials.gov: NCT01585285.
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