Multiple arterial conduits for multi-vessel coronary artery bypass grafting in patients with mild to moderate left
Hang Zhang1, Wen Chen1, Yang Zhao2
1Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, China.
Insights
Multiple arterial grafts in coronary artery bypass grafting (CABG) improve mid-term outcomes for patients with left ventricular systolic dysfunction (LVSD). This approach reduces major adverse events and repeat revascularization compared to single arterial grafts.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Arterial Grafting
Background:
- Multiple arterial conduits offer advantages in coronary artery bypass grafting (CABG).
- Previous studies reported benefits, but mid-term outcomes in patients with mild to moderate left ventricular systolic dysfunction (LVSD) require further evaluation.
Purpose of the Study:
- To evaluate the mid-term outcomes of multiple arterial CABG (MABG) versus single arterial CABG in patients with mild to moderate LVSD.
- To compare major adverse events, cardiovascular events, and graft patency between MABG and conventional CABG.
Main Methods:
- A multicenter propensity score-matched study was conducted from January 2013 to June 2019 in China.
- Included patients with mild to moderate LVSD undergoing primary, isolated multi-vessel CABG using the left internal thoracic artery.
- Compared in-hospital and mid-term outcomes of MABG versus single arterial CABG (left internal thoracic artery + saphenous vein grafts).
Main Results:
- After matching, 243 patients were in the MABG group and 676 in the single arterial CABG group.
- No significant difference in in-hospital mortality (1.6% vs 2.2%, p=0.78).
- MABG showed significantly lower rates of major adverse events (HR 0.64; p=0.019), myocardial infarction (HR 0.39; p=0.045), and repeat revascularization (HR 0.42; p=0.034) at a mean follow-up of 3.3 years.
Conclusions:
- Multiple arterial CABG is associated with reduced mid-term major adverse events and cardiovascular events in patients with mild to moderate LVSD.
- MABG may be the preferred surgical strategy for this patient population.
- No significant difference observed in stroke or sternal wound infection rates.
Background:
Advantages of multiple arterial conduits for coronary artery bypass grafting (CABG) have been reported previously. We aimed to evaluate the mid-term outcomes of multiple arterial CABG (MABG) among patients with mild to moderate left ventricular systolic dysfunction (LVSD).
Methods:
This multicenter study using propensity score matching took place from January 2013 to June 2019 in Jiangsu Province and Shanghai, China, with a mean and maximum follow-up of 3.3 and 6.8 years, respectively. We included patients with mild to moderate LVSD, undergoing primary, isolated multi-vessel CABG with left internal thoracic artery. The in-hospital and mid-term outcomes of MABG versus conventional left internal thoracic artery supplemented by saphenous vein grafts (single arterial CABG) were compared. The primary end points were death from all causes and death from cardiovascular causes. The secondary end points were stroke, myocardial infarction, repeat revascularization, and a composite of all mentioned outcomes, including death from all causes (major adverse events). Sternal wound infection was included with 6 months of follow-up after surgery.
Results:
243 and 676 patients were formed in MABG and single arterial CABG cohorts after matching in a 1:3 ratio. In-hospital death was not significantly different (MABG 1.6% versus single arterial CABG 2.2%, p = 0.78). After a mean (±SD) follow-up time of 3.3 ± 1.8 years, MABG was associated with lower rates of major adverse events (HR, 0.64; 95% CI, 0.44-0.94; p = 0.019), myocardial infarction (HR, 0.39; 95% CI, 0.16-0.99; p = 0.045) and repeat revascularization (HR, 0.42; 95% CI, 0.18-0.97; p = 0.034). There was no difference in the rates of death, stroke, and sternal wound infection.
Conclusions:
MABG was associated with reduced mid-term rates of major adverse events and cardiovascular events and may be the procedure of choice for patients with mild to moderate LVSD requiring CABG.
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