Multiple Versus Single Arterial Coronary Arterial Bypass Grafting Surgery for Multivessel Disease in Atrial
Mariusz Kowalewski1, Michał Pasierski2, Radosław Litwinowicz3
1Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland; Innovative Medical Forum, Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland; Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.
Insights
Multiple arterial grafting (MAG) improves mid-term survival in coronary artery bypass grafting (CABG) patients with atrial fibrillation (AF). This approach is safe and particularly beneficial for lower-risk individuals, enhancing long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Arterial Grafting Techniques
Background:
- Observational studies suggest improved outcomes with multiple arterial grafting (MAG) versus single arterial grafting (SAG) in coronary artery bypass grafting (CABG).
- Preoperative atrial fibrillation (AF) affects approximately 6% of CABG patients, but MAG vs. SAG comparisons in this specific population are understudied.
Purpose of the Study:
- To compare the mid-term survival outcomes of multiple arterial grafting (MAG) versus single arterial grafting (SAG) in patients with multivessel coronary artery disease and preoperative atrial fibrillation undergoing isolated CABG.
Main Methods:
- Retrospective analysis of 5738 patients with multivessel coronary artery disease and AF undergoing isolated CABG from the Polish National Registry of Cardiac Surgery Procedures (2006-2019).
- Propensity score matching was used to create comparable subsets of MAG (591 patients) and SAG (1773 patients) groups.
- Primary endpoint was mid-term survival, with a median follow-up of 5 years.
Main Results:
- No significant differences in in-hospital outcomes or 1-year mortality risk were observed between MAG and SAG groups (HR 1.13; P=0.469).
- Multiple arterial grafting (MAG) was associated with a significant 20% improvement in mid-term survival compared to SAG (HR 0.80; P=0.026).
- This survival benefit was most pronounced in lower-risk patients (under 70 years old, EuroSCORE <2, no diabetes) and when complete revascularization was achieved.
Conclusions:
- Multiple arterial grafting (MAG) is a safe approach compared to single arterial grafting (SAG) in patients with atrial fibrillation undergoing CABG.
- MAG is associated with improved mid-term survival in this patient cohort.
- A notable survival advantage with MAG was observed particularly in lower-risk patient subgroups.
Abstract:
Observational studies suggest improved outcomes with multiple (MAG) as compared to single arterial grafting (SAG) in patients with multivessel coronary artery disease and undergoing coronary artery bypass grafting (CABG). Even though around 6% of CABG patients have preoperative atrial fibrillation, previous studies did not address MAG versus SAG comparison in this setting. Data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. 5738 patients with multivessel coronary artery disease and AF (77.9% men, mean age 69.0 ± 8.0) undergoing isolated CABG surgery between 2006 and 2019 in 37 reference centers across Poland were analyzed. Propensity score matching was performed. Primary endpoint was mid-term survival. Median follow-up was 5 years ([IQR 1.9-7.6], max.13). One-to-three Propensity score matching included 2364 patients divided into MAG (591) and SAG (1773) subsets. Subjects were no different in terms of baseline risk and surgical characteristics. Number of distal anastomoses was 2.82 ± 0.83 versus 2.80 ± 0.75 (P = 0.516) for MAG and SAG, respectively. In-hospital outcomes and mortality risk at 1-year (hazard ratio, 95% confidence intervals: 1.13 [0.81-1.58]; P = 0.469) was unchanged with MAG. Multiple arterial grafting was associated with 20% improved mid-term survival: HR 0.80; (95% confidence intervals: 0.65-0.97); P = 0.026. Benefit was sustained in subgroup analyses, yet most appraised in low risk patients (<70-year-old; EuroSCORE <2; no diabetes) and when complete revascularization was achieved. Multiple as compared to single arterial grafting in atrial fibrillation patients undergoing CABG is safe and associated with improved mid-term survival. A particular survival benefit was observed in lower risk patients.
