A pilot randomized controlled trial comparing CABG surgery performed with total arterial grafts or without

Area of Science:

• Cardiovascular Surgery
• Surgical Innovation
• Clinical Trials

Background:

• Limited randomized controlled trials (RCTs) compare different coronary artery bypass grafting (CABG) strategies.
• Conventional CABG uses internal mammary artery (LIMA) and vein grafts (SVG).
• Total arterial grafting (TAG) offers an alternative arterial conduit approach.

Purpose of the Study:

• To assess the feasibility of a pilot RCT comparing LIMA+SVG versus TAG in multi-vessel coronary disease.
• To identify recruitment and follow-up challenges for future large-scale trials.
• To evaluate preliminary graft patency and safety between the two strategies.

Main Methods:

• A pilot randomized controlled trial (RCT) was conducted at a single institution.
• Patients undergoing isolated CABG were randomized to TAG or LIMA+SVG.
• Primary feasibility endpoints included enrollment rate (>20%) and 6-month CT angiography completion (>80%).

Main Results:

• The study achieved a 14% enrollment rate, falling short of the target.
• 76% of patients completed 6-month CT angiography, below the 80% goal.
• Both groups showed excellent graft patency (TAG: 89%, LIMA+SVG: 91%) with no significant difference in adverse events.

Conclusions:

• Conducting an RCT comparing CABG grafting strategies is possible.
• Recruitment and follow-up CT completion pose significant feasibility challenges.
• The required sample size may make comparing 6-month graft patency infeasible as a primary endpoint.