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Published on: May 14, 2013
Multiple arterial bypass grafting should be routine
Robert F Tranbaugh1, David J Lucido2, Kamellia R Dimitrova1
1Department of Cardiovascular Surgery, Mount Sinai Beth Israel, New York, NY.
Insights
Widespread adoption of routine multiple arterial bypass grafting (MABG) could significantly reduce annual deaths and extend lifespans. Increasing MABG rates could save thousands of lives and add tens of thousands of life-years over a decade.
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.
Objective:
We sought to estimate the reduction in deaths and the number of additional person-years of life that could potentially be gained by nationwide adoption of routine multiple arterial bypass grafting (MABG).
Methods:
Propensity matching on 4883 patients undergoing primary, isolated coronary artery bypass grafting (CABG) using the left internal thoracic artery (LITA) from January 1995 to June 2011, resulted in 1023 matched pairs of LITA-radial artery and LITA-saphenous vein patients. Kaplan-Meier estimated survivals were used to calculate the potential number of lives that could be saved based on a 20% and an 80% rate of MABG, compared with the national 10% rate, when applied to a hypothetical national sample of 200,000 similar patients.
Results:
Our overall MABG rate was 40% with >80% rate for the past 3 years. Kaplan-Meier estimated 10-year survival was better for LITA-radial artery patients (83.1%) compared with LITA-saphenous vein patients (75.7%) (log rank test, P < .001). When compared with the current national 10% MABG rate, a 20% and an 80% MABG rate could potentially result in 1400 and 10,000 fewer annual deaths, respectively, among a hypothetical national cohort, yielding >9000 and >64,000 person-years of life over a 10-year period.
Conclusions:
An 80% rate of MABG has the potential to prevent more than 10,000 deaths annually and add >64,000 person-years of life over the course of 10 years. The use of a second arterial graft during CABG should be routine in the majority of patients undergoing CABG.
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