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Long Term Survival Benefits of Different Conduits Used in Coronary Artery Bypass Graft Surgery- A Single
Aziz Momin1, Redoy Ranjan1,2, Oswaldo Valencia1
1Department of Cardiac Surgery, St George's University Hospitals NHS Foundation Trust, London, UK.
Insights
Total arterial coronary artery bypass graft (CABG) surgery demonstrates excellent long-term survival, especially when using bilateral internal mammary arteries. Reduced survival is observed with fewer arterial grafts, highlighting their importance in CABG outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a critical intervention for ischemic heart disease.
- Optimizing graft choice is essential for long-term patient survival and outcomes.
- Assessing the long-term efficacy of different arterial grafting strategies is crucial for surgical decision-making.
Purpose of the Study:
- To determine hazard factors and long-term survival rates following total arterial coronary artery bypass graft surgery.
- To compare the survival outcomes of various arterial grafting configurations in a large population-based cohort over 20 years.
Main Methods:
- A retrospective analysis of 2979 patients undergoing isolated CABG between April 1999 and March 2020.
- Patients were categorized into four groups based on graft types: bilateral internal mammary artery (BIMA) ± radial artery, single internal mammary artery (SIMA) + radial artery ± saphenous vein, SIMA ± saphenous vein, and radial artery ± saphenous vein.
- Kaplan-Meier survival analysis and Holm-Sidak statistical methods were employed to evaluate graft type and number correlations with survival.
Main Results:
- The total arterial revascularization group (BIMA ± radial artery) achieved a mean long-term survival of approximately 19 years.
- Survival rates were 18.6 years for SIMA + radial artery, 15.86 years for SIMA, and 10.99 years for radial artery ± saphenous vein.
- A statistically significant survival advantage was associated with the number of arterial grafts, particularly total arterial revascularization.
Conclusions:
- Total arterial CABG, especially using BIMA, offers excellent long-term survival and complete myocardial revascularization.
- No significant difference in survival was noted between BIMA and SIMA with radial artery configurations.
- Reduced survival rates correlate with a decreased use of arterial conduits in CABG surgery.
Objective:
This study determined hazard factors and long-term survival rate of total arterial coronary artery bypass graft surgery over 20 years in an extensively large, population-based cohort.
Methods:
A total of 2979 patients who underwent isolated CABG from April 1999 to March 2020 were studied in 4 groups- Group-A (bilateral internal mammary artery ± radial artery), Group-B (single internal mammary artery + radial artery ± saphenous vein), Group-C (single internal mammary artery ± saphenous vein; no radial artery), and Group-D (radial artery ± saphenous vein; no internal mammary artery). The study endpoints analysed the correlation between the number and types of grafts with the survival time following isolated CABG surgery.
Results:
The total arterial revascularization (Group A) group had an admirable mean long-term survival of ~19 years, compared to 18.6 years (Group B), 15.86 years (Group C), and 10.99 years (Group D). A Kaplan-Meier curve demonstrated confidence interval (CI) for study groups- (95% CI 18.33-19.94), (95% CI 18.14-19.06), (95% CI 15.40-16.32), and (95% CI 9.61-12.38) in Group A, B, C, D respectively. In the Holm-Sidak method analysis, significant associations existed between the number of arterial grafts and the long-term outcome. A statistically significant (P≤0.05) long-term survival advantage for arterial grafting was demonstrated, especially total arterial revascularisation over all other combinations except single internal mammary artery + radial artery grafting.
Conclusion:
In this series, over 20 years, total arterial CABG use has excellent long-term survival, achieving complete myocardial revascularisation. There is no significant difference between the BIMA group and SIMA with radial artery. However, there is a reduced survival with decreased use of arterial conduits.
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