Clinical and Angiographic Outcomes in Coronary Artery Bypass Surgery with Multiple versus Single Distal Target Grafts

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Outcomes

Background:

• Coronary artery bypass grafting (CABG) using multiple distal target (MDT) grafts may reduce graft material and cardiopulmonary bypass time.
• However, concerns exist regarding potentially higher graft failure rates with MDT grafts.
• Long-term outcome data for MDT grafts in real-world settings are limited.

Purpose of the Study:

• To compare long-term outcomes of MDT grafts versus single distal target (SDT) grafts in patients undergoing isolated first-time CABG.
• To evaluate the impact of MDT grafts on complete revascularization (CR) and mortality.
• To provide real-world evidence on the safety and efficacy of MDT grafts.

Main Methods:

• A propensity-matched analysis of 6262 patients undergoing isolated first CABG between 2004-2012.
• Patients with MDT grafts were matched to those with SDT grafts.
• Outcomes included 30-day, 1-year, and long-term mortality, with logistic regression adjusting for CR definitions.

Main Results:

• Complete revascularization (CR) was more frequent in the MDT group across traditional, anatomical, and functional definitions.
• No significant differences in 30-day, 1-year, or long-term mortality were observed between MDT and SDT groups.
• Graft failure rates were 37.8% for MDT and 27.6% for SDT, though this difference was not statistically significant.

Conclusions:

• In a contemporary, population-based cohort, MDT CABG grafts showed no difference in mortality compared to SDT grafts.
• MDT grafts facilitate complete revascularization and are a safe option, particularly when graft material is limited.
• These findings support the use of MDT grafts in selected CABG patients.