Does the Addition of a Gastroepiploic Artery to Bilateral Internal Thoracic Artery Improve Survival?

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Olivier J L Jegaden1, Fadi Farhat2, Margaux P O Jegaden3

  • 1Department of cardiac surgery, Mediclinic Middle East Abu Dhabi, UAE; Department of surgery MBRU University, Dubai, UAE; Department of surgery UCLB University Lyon, France.

Seminars in Thoracic and Cardiovascular Surgery
|February 18, 2021
PubMed

Insights

Using the gastroepiploic artery (GEA) as a third arterial conduit in bilateral internal thoracic artery (BITA) grafting does not impact long-term patient survival compared to vein grafts (SVG). This finding holds true even when accounting for patient risk factors in coronary artery bypass surgery.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Surgery

Background:

  • Bilateral internal thoracic artery (BITA) grafting is a common strategy in coronary artery bypass grafting (CABG).
  • The choice of the third conduit to supplement BITA for revascularization of the right coronary system remains debated.
  • Gastroepiploic artery (GEA) and saphenous vein graft (SVG) are commonly used alternatives.

Purpose of the Study:

  • To compare the long-term survival outcomes of patients undergoing left-sided BITA grafting using either GEA or SVG as the third conduit to the right coronary artery (RCA).

Main Methods:

  • A retrospective study of 1432 consecutive patients undergoing left-sided BITA grafting from 1989 to 2014.
  • Patients received either SVG (n=599) or GEA (n=833) as the third conduit to the RCA.
  • Propensity score matching was used to create comparable groups of 320 patients each for analysis.

Main Results:

  • Overall 30-day mortality was 1.6% and not influenced by graft configuration.
  • Long-term follow-up (13.6 ± 6.6 years) was 94% complete.
  • In propensity score-matched groups, there was no significant difference in overall mortality between GEA and SVG (41 ± 7% vs 36 ± 7%, P=0.112).
  • Multivariable analysis revealed that the choice of third conduit (GEA vs. SVG) did not affect long-term survival.
  • Complete revascularization, age, diabetes status, and left ventricle ejection fraction were significant predictors of survival.

Conclusions:

  • The use of GEA as a third arterial conduit in BITA grafting does not negatively impact long-term survival compared to SVG.
  • Complete revascularization is a critical determinant of long-term survival in patients undergoing BITA grafting.
  • Further research is warranted to evaluate the impact of GEA versus SVG on long-term cardiac events.

Keywords:
Arterial revascularizationCoronary artery bypass surgeryGastroepiploic arteryInternal thoracic artery

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