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Total Arterial Revascularization: Achievable and Prognostically Effective-A Multicenter Analysis.

James Tatoulis1, Rochelle Wynne2, Peter D Skillington2

  • 1Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia; Department of Surgery, The University of Melbourne, Melbourne, Australia.

The Annals of Thoracic Surgery
|July 21, 2015
PubMed
Summary
This summary is machine-generated.

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Total arterial revascularization (TAR) improves long-term survival after coronary artery bypass surgery. This multicenter study found TAR associated with lower mortality rates compared to traditional methods.

Area of Science:

  • Cardiovascular Surgery
  • Surgical Outcomes Research
  • Graft Patency Studies

Background:

  • Total arterial revascularization (TAR) aims to prevent late vein graft atherosclerosis and occlusion.
  • TAR adoption is limited despite evidence of superior survival.
  • Previous studies often lacked long-term follow-up and multicenter data.

Purpose of the Study:

  • To evaluate the long-term survival impact of TAR.
  • To compare outcomes between TAR and non-TAR patients in a large multicenter cohort.
  • To assess the influence of TAR on 10-year all-cause late mortality.

Main Methods:

  • Analysis of 34,181 first-time isolated coronary artery bypass (CABG) patients (2001-2012) from a multicenter database.
  • Comparison of outcomes between TAR (n=12,271) and non-TAR (n=21,910) groups.

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  • Propensity score matching (6,232 pairs) and Cox proportional hazards models to assess 10-year mortality.
  • Main Results:

    • TAR group had significantly lower 30-day (0.8% vs 1.8%) and late mortality (7.5% vs 8.9%).
    • In propensity-matched pairs, TAR showed lower perioperative mortality (0.9% vs 1.2%).
    • Kaplan-Meier survival at 10 years was higher for TAR (85.4%) vs non-TAR (81.2%), with a reduced risk of late mortality (HR 0.80).

    Conclusions:

    • Total arterial revascularization is linked to reduced perioperative mortality.
    • TAR significantly improves long-term survival following coronary artery bypass grafting.
    • Wider application of TAR may be beneficial for patient outcomes.