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Updated: Jun 10, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Impact of More Than 1 Distal Anastomosis on the Same Territory in 3-Vessel Disease Patients
Han Cho1, Ji Seong Kim1, Yoonjin Kang1
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Insights
For patients with three-vessel disease (3VD) undergoing coronary artery bypass grafting (CABG), achieving more than complete revascularization with multiple grafts per territory significantly reduces mortality. This strategy improves long-term survival and cardiac outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Complete revascularization in coronary artery bypass grafting (CABG) traditionally involves at least one bypass graft per diseased coronary territory.
- The benefit of revascularizing more than one vessel within each diseased territory in patients with three-vessel disease (3VD) remains an area of investigation.
Purpose of the Study:
- To evaluate the impact of achieving more than complete revascularization (i.e., >1 graft per territory) on patient outcomes after CABG for 3VD.
- To determine if exceeding the standard definition of complete revascularization offers additional survival benefits.
Main Methods:
- Retrospective analysis of 1008 patients who underwent off-pump coronary artery bypass grafting (OPCAB) for 3VD with complete revascularization.
- Patients were categorized based on the number of distal anastomoses: >3 versus 3.
- Inverse probability treatment weighting-adjusted multivariate analyses were used to assess outcomes.
Main Results:
- Patients with >3 distal anastomoses (n=829) showed a significantly lower hazard ratio for all-cause mortality (0.76) and cardiac death (0.50) compared to those with 3 anastomoses (n=179).
- Five- and 10-year all-cause mortality rates were 18.0% and 36.0% respectively, with cardiac death rates of 5.2% and 9.2% respectively.
- Hypertension and diabetes were common comorbidities, with no significant intergroup differences.
Conclusions:
- Performing more than one distal anastomosis per diseased coronary territory during CABG for 3VD is associated with improved long-term survival.
- This strategy may offer significant benefits in reducing both all-cause mortality and cardiac death in patients with complex coronary artery disease.
Background:
Previous studies defined complete revascularization as the placement of at least 1 bypass graft to each diseased coronary territory. This study was conducted to evaluate whether putting more than 1 graft to each diseased coronary territory is beneficial for patients with 3-vessel disease (3VD) who underwent coronary artery bypass grafting (CABG).
Methods:
Among 1859 patients who underwent primary isolated CABG, 1008 patients (male-to-female ratio, 841:239; mean age, 67.0 ± 9.3 years) who underwent OPCAB for 3VD and in whom complete revascularization was achieved were retrospectively enrolled. Complete revascularization was defined as at least 1 graft to each coronary artery territory. The median follow-up duration was 86.6 months (interquartile range, 53.0-126.9).
Results:
A total of 829 patients (82.2%) had more than 3 distal anastomoses, whereas the other 179 patients had 3 distal anastomoses. Hypertension (n = 729; 72.3%) and diabetes (n = 556; 55.2%) were the most common comorbidities without any intergroup differences. The early mortality rate was 1.0% (n = 10). Late death occurred in 337 of 998 early survivors. Five- and 10-year all-cause mortality rates were 18.0% and 36.0%, respectively. Cumulative incidences of cardiac deaths were 5.2% and 9.2%, respectively. The inverse probability treatment weighting-adjusted multivariate analyses showed that having more than 3 distal anastomoses was associated with lower all-cause mortality and cardiac death (hazard ratio, 0.76 [95% CI, 0.57-0.99] and hazard ratio, 0.50 [95% CI, 0.31-0.83], respectively).
Conclusions:
Grafting more than 1 diseased vessel in each diseased coronary territory during CABG may be beneficial for patients with 3VD in terms of all-cause mortality and cardiac death.
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