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The Impact of Multiarterial Grafting in Patients with Left Ventricular Dysfunction
Tom Ronai1,2, Dana Abraham1,2, Ely Erez3
1Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel.
Insights
Multiple arterial grafting (MAG) improves outcomes after coronary artery bypass grafting (CABG) for patients with left ventricular dysfunction. This strategy benefits patients across all ranges of left ventricle (LV) function.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Arterial Grafting Techniques
Background:
- Coronary artery bypass grafting (CABG) is a key revascularization method for patients with left ventricular dysfunction (LVD).
- Multiple arterial grafting (MAG) offers superior long-term results compared to single arterial grafting (SAG).
- Limited data exist on MAG's specific benefits in LVD patients.
Purpose of the Study:
- To evaluate the impact of MAG versus SAG on clinical outcomes in patients undergoing isolated CABG.
- To analyze outcomes across the full spectrum of left ventricle (LV) function, including varying ejection fraction (EF) levels.
Main Methods:
- A retrospective cohort study included 4,763 patients undergoing isolated CABG between January 1, 2009, and October 1, 2021.
- Patients were categorized into single arterial grafting (SAG) or multiple arterial grafting (MAG) groups.
- The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of mortality, stroke, myocardial infarction, and revascularization, analyzed using Kaplan-Meier curves and stratified by LV function (EF <30%, 30-50%, >50%).
Main Results:
- The study included 4,763 patients (58.6% MAG, 41.4% SAG) with a median follow-up of 64 months.
- Overall MACCE at 72 months was 28.7% for MAG versus 30.3% for SAG.
- Stratified by LV function, MAG showed a reduced hazard ratio for MACCE at 160 months (0.71 for EF <30%, 0.78 for EF 30-50%, 0.95 for EF >50%), indicating improved outcomes across all groups without significant interaction.
Conclusions:
- Multiple arterial grafting (MAG) is associated with improved clinical outcomes following coronary artery bypass grafting (CABG).
- The benefits of MAG extend across the entire spectrum of left ventricle (LV) function, including patients with reduced ejection fraction.
- MAG represents a favorable revascularization strategy for CABG patients regardless of their LV function status.
Abstract:
Coronary artery bypass grafting (CABG) is one of the revascularization modalities available in patients with left ventricular dysfunction (LVD). Multiple arterial grafting (MAG) is associated with improved long-term outcomes. Data on the benefits of MAG in patients with LVD are limited. We examined the effect of MAG on outcomes across the spectrum of left ventricle (LV) function.Retrospective cohort study of patients undergoing isolated CABG (January 1, 2009, to October 1, 2021). Patients were grouped according to revascularization strategy (single vs. MAG). The primary outcome was a composite of all-cause mortality, cerebrovascular accident, myocardial infarction, and repeat revascularization (major adverse cardiac and cerebrovascular events [MACCE]). The cumulative incidence of MACCE was plotted using Kaplan-Meier curves. Results were stratified according to LV function (<30%, 30-50%, >50%).Our cohort included 4,763 patients; 1,976 (41.4%) underwent single arterial grafting (SAG), and 2,787 (58.6%) underwent MAG; 3,976 (83.4%) were male with a median age of 64 (interquartile range [IQR] 57-71) years. Distribution of LV function was 2,539 (53.3%) with an ejection fraction (EF) >50%, 1,828 (38.3%) with an EF of 30-50%, and 396 (8.3%) with an EF <30%. Median follow-up time was 64 (37-102) months. Cumulative incidence of MACCE at 72 months was 28.7% in the MAG and 30.3% in the SAG group. Stratified by LV function, the hazard ratio for MACCE at 160 months was 0.71 (95% CI 0.54-0.93), 0.78 (95% CI 0.68-0.9), and 0.95 (95% CI 0.83-1.09) for LV function <30%, 30-50%, >50%, respectively, with no significant interaction between MAG and LV function.MAG is associated with improved outcomes following CABG across the spectrum of LV function.
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