Related Experiment Video
Updated: Nov 22, 2025
Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
How decisive is the number of distal arterial anastomoses in coronary bypass surgery?
Olivier J L Jegaden1,2,3, Fadi Farhat4,5, Margaux P O Jegaden6
1Department of Cardiac Surgery, Mediclinic Middle East, Mediclinic Airport Road Hospital, PO Box 48481, Abu Dhabi, UAE. jegadenolivier@gmail.com.
Insights
The number of distal arterial anastomoses (DAA) is a key predictor of long-term survival in coronary artery bypass grafting (CABG) surgery. Performing three or more DAA significantly improves patient outcomes, supporting extensive arterial grafting.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Arterial revascularization benefits in coronary surgery are debated.
- Assessing the value of additional grafts primarily by graft count may obscure the true impact.
- This study investigates the influence of distal arterial anastomoses (DAA) on late mortality.
Purpose of the Study:
- To determine the impact of the number of distal arterial anastomoses (DAA) on late mortality.
- To compare the prognostic significance of DAA versus the number of arterial grafts and complete revascularization.
- To evaluate the optimal number of DAA for long-term survival in coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective review of 3685 primary isolated CABG procedures (1989-2014) with a 13-year mean follow-up.
- Analysis of patient outcomes based on the number of DAA performed (1 to 4+).
- Sub-group analysis in 2104 patients with 3-vessel disease receiving at least 2 arterial grafts.
Main Results:
- Late mortality was influenced by patient factors and technical aspects, including DAA.
- The number of DAA was the sole significant independent predictor of late survival (p < 0.0001), outranking graft count and complete revascularization.
- Survival benefit increased with DAA up to three; no additional benefit was observed beyond three DAA.
Conclusions:
- The number of distal arterial anastomoses (DAA) independently predicts long-term survival in CABG.
- Higher DAA numbers correlate with better late survival, emphasizing their importance over graft quantity.
- Findings support the extensive use of arterial grafting in CABG to maximize patient survival.
Background:
The benefit of arterial revascularization in coronary surgery remains controversial. The incremental value of additional grafts to the left internal thoracic artery (ITA) has been mainly assessed according to the number of arterial grafts, possibly limiting the detection of its actual impact. We analyzed the influence of the number of distal arterial anastomoses (DAA) performed on late mortality in patients having received from one to three arterial grafts.
Methods:
Retrospective review of 3685 primary isolated coronary artery bypass grafting (CABG) performed from 1989 to 2014 was conducted with a 13-year mean follow-up. One arterial graft (SITA) was used in 969 patients, two arterial grafts, ITA or gastroepiploic artery (GEA), in 1883 patients (BITA: 1644; SITA+GEA: 239), and three arterial grafts in 833 patients (BITA+GEA). Totally, 795 patients (22%) received one DAA, 1142 patients (31%) two, 1337 patients (36%) three, and 411 patients (11%) four or more. A sub-group analysis was done in the 2104 patients with 3-vessel disease who received at least 2 arterial grafts.
Results:
In this series the early mortality was 1.6% and it was not influenced by the surgical technique. Late mortality was significantly influenced by age, gender, heart failure, LV ejection fraction, diabetes status, complete revascularization, number of arterial grafts, number of DAA, both ITA, sequential ITA graft, GEA graft. In multivariable analysis with Cox regression model, the number of DAA was the only technical significant independent prognosis factor of late survival (p < 0.0001), predominant over both ITA, complete revascularization and number of arterial grafts. The impact of the number of DAA on survival was found discriminant from 1 to 3; after 3 there was no more additional effect. In 3-vessel disease patients who received at least 2 arterial grafts, the number of DAA remained a significant independent prognosis factor of late survival (p < 0.0001).
Conclusions:
The number of distal arterial anastomoses is an independent predictor of long-term survival, predominant over the number of arterial grafts and the completeness of the revascularization; higher the number, better the late survival. It is a strong support of the extensive use of arterial grafting in CABG.
Related Concept Videos
01:19Anastomoses
Anastomoses can be formed at arterial, venous, and lymphatic vessels.
Arterial Anastomosis: These occur between arteries. They...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Aneurysm III: Interprofessional Care