Multiple arterial bypass grafting should be routine

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Coronary artery bypass grafting (CABG) is a common surgical procedure.
• The use of multiple arterial grafts (MABG) in CABG may improve long-term outcomes.
• Current national MABG rates are suboptimal.

Purpose of the Study:

• To estimate the potential reduction in mortality and increase in life-years gained with nationwide adoption of routine MABG.
• To compare survival outcomes between different arterial graft configurations in CABG patients.

Main Methods:

• Propensity matching of 1023 pairs of patients undergoing primary, isolated CABG using left internal thoracic artery (LITA) with either a radial artery or saphenous vein graft.
• Kaplan-Meier survival analysis to estimate 10-year survival rates.
• Modeling of potential lives saved and life-years gained based on varying MABG rates (20% and 80%) compared to the national rate (10%) in a hypothetical cohort of 200,000 patients.

Main Results:

• 10-year survival was significantly better for LITA-radial artery grafts (83.1%) compared to LITA-saphenous vein grafts (75.7%).
• A nationwide MABG rate of 20% could potentially prevent 1400 annual deaths and yield over 9000 person-years of life over 10 years.
• An 80% MABG rate could potentially prevent 10,000 annual deaths and yield over 64,000 person-years of life over 10 years.

Conclusions:

• Routine use of a second arterial graft in CABG is associated with improved survival.
• Nationwide implementation of MABG at an 80% rate could prevent over 10,000 deaths annually and add more than 64,000 life-years over a decade.
• MABG should be considered the standard of care for the majority of CABG patients.