A Single-Surgeon Experience Transitioning to Total Arterial Revascularization

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Minimally Invasive Cardiac Surgery

Background:

• Coronary artery bypass grafting (CABG) is standard for advanced coronary artery disease.
• Total arterial revascularization (TAR) is underutilized due to concerns like sternal wound infections and learning curve.
• This study evaluates outcomes for mid-career surgeons transitioning to TAR.

Purpose of the Study:

• To assess short-term outcomes of total arterial revascularization (TAR) in CABG.
• To evaluate the learning curve associated with adopting TAR by experienced surgeons.
• To compare TAR outcomes against traditional CABG using internal mammary artery and vein grafts (IMA-SVG).

Main Methods:

• A cohort of isolated, non-emergent CABG patients from January 2014 to January 2022 was reviewed.
• Patients were divided into TAR and traditional IMA-SVG groups.
• Outcomes including operative time, ICU stay, readmissions, and complications were compared.

Main Results:

• The TAR group experienced longer bypass, cross-clamp, and operative times.
• TAR was associated with shorter ICU stays, lower 30-day readmission rates, and fewer postoperative transfusions.
• No significant differences were observed in prolonged intubation, stroke, length of stay, mortality, or sternal wound complications.

Conclusions:

• Transitioning to TAR slightly increases operative time but improves key short-term outcomes.
• TAR adoption by experienced surgeons shows a minimal learning curve.
• TAR is a safe and effective revascularization strategy with comparable or improved outcomes to IMA-SVG.