Importance of the third arterial graft in multiple arterial grafting strategies

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• The long-term benefits of using multiple arterial grafts in coronary artery bypass grafting (CABG) remain unclear.
• Conventional strategies for CABG often involve single arterial grafts or vein grafts.
• This study aimed to clarify the long-term outcomes associated with multiple arterial grafts.

Purpose of the Study:

• To evaluate the long-term efficacy of multiple arterial grafts compared to conventional strategies in CABG.
• To determine if bilateral internal thoracic artery (BITA) grafting with a right gastro-epiploic artery (RGEA) improves survival outcomes.
• To compare the use of RGEA versus saphenous vein graft (SVG) as a third conduit in CABG patients.

Main Methods:

• Prospective data collection from 588 patients undergoing isolated CABG between 1985 and 1995.
• Analysis of long-term survival and freedom from cardiac death.
• Comparison of patients receiving BITA grafting with RGEA versus SVG as a third conduit, using Cox proportional hazards modeling for confounder adjustment.

Main Results:

• A mean follow-up of 16.1 years was achieved.
• Multivariable analysis indicated that patients receiving RGEA as a third conduit had significantly superior overall survival (HR, 0.46; P=0.015).
• Patients with RGEA also demonstrated superior cardiac survival (HR, 0.20; P=0.005) compared to those receiving SVG.

Conclusions:

• Multiple arterial grafting is independently linked to superior long-term outcomes in CABG patients.
• Consideration of a third arterial conduit, specifically the RGEA, targeted to the right coronary artery (RCA) may enhance long-term survival.
• The findings support the expanded use of arterial grafts in CABG for improved patient prognosis.