Multiple Arterial Grafting in Patients With Low Left Ventricular Ejection Fraction
Kohei Hachiro1, Noriyuki Takashima1, Kenichi Kamiya1
1Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science.
Insights
Multiple arterial grafting (MAG) significantly reduces long-term mortality in patients with reduced ejection fraction undergoing off-pump coronary artery bypass grafting compared to single arterial grafting (SAG). This finding offers crucial insights for surgical strategy in high-risk cardiac patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Surgery
Background:
- Patients with preoperative left ventricular ejection fraction (LVEF) ≤35% represent a high-risk group for coronary artery bypass grafting (CABG).
- Off-pump CABG aims to reduce surgical trauma, but graft selection remains critical for long-term outcomes in this cohort.
Purpose of the Study:
- To compare postoperative outcomes between multiple arterial grafting (MAG) and single arterial grafting (SAG) in patients with LVEF ≤35% undergoing off-pump isolated CABG.
- To evaluate the impact of grafting strategy on long-term all-cause and cardiac mortality.
Main Methods:
- Retrospective analysis of 1,627 patients undergoing isolated CABG between 2002 and 2023.
- Focus on 176 patients with preoperative LVEF ≤35% who received either MAG (n=115) or SAG (n=61).
- Inverse probability of treatment weighting (IPTW) was used for baseline characteristic adjustment, followed by Kaplan-Meier survival analysis and multivariable Cox proportional hazards modeling.
Main Results:
- After IPTW adjustment, mean follow-up was 4.8±4.7 years.
- Estimated 5-year freedom from all-cause death was 71.5% for MAG vs. 69.1% for SAG.
- Estimated 5-year freedom from cardiac death was 94.1% for MAG vs. 89.5% for SAG.
- Kaplan-Meier analysis revealed significant differences favoring MAG for both all-cause death (P=0.013) and cardiac death (P=0.001).
- MAG was independently associated with reduced all-cause death (HR 0.568; P=0.034) and cardiac death (HR 0.276; P=0.008).
Conclusions:
- Multiple arterial grafting is associated with significantly lower rates of all-cause and cardiac death compared to single arterial grafting in patients with reduced LVEF undergoing off-pump CABG.
- The findings suggest MAG as a superior revascularization strategy for improving long-term survival in this vulnerable patient population.
Background:
This study compared postoperative outcomes in patients with a preoperative left ventricular ejection fraction (LVEF) of ≤35% who underwent multiple (MAG) or single (SAG) arterial grafting during off-pump isolated coronary artery bypass grafting.
Methods And Results:
Of 1,627 patients who underwent isolated coronary artery bypass grafting at Shiga University of Medical Science between 2002 and 2023, 176 with a preoperative LVEF ≤35% underwent MAG (n=115) or SAG (n=61). Baseline patient characteristics were comparable in the MAG and SAG groups after adjustment using inverse probability of treatment weighting. The study's mean (±SD) follow-up duration was 4.8±4.7 years. In the MAG and SAG groups, the adjusted estimated 5-year rates of freedom from all-cause death were 71.5% and 69.1%, respectively, while those of cardiac death were 94.1% and 89.5%, respectively. Kaplan-Meier curves showed significant differences in all-cause death (P=0.013) and cardiac death (P=0.001) favoring the MAG group. In a multivariable Cox hazards model, MAG was a predictor of all-cause death (hazard ratio 0.568; P=0.034) and cardiac death (hazard ratio 0.276; P=0.008).
Conclusions:
Compared with SAG, MAG was associated with significantly lower rates of all-cause death and cardiac death.
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