No-Touch Aorta Off-Pump LIMA-Radial Artery Y-Graft CABG as a Safe Strategy for All-Comers: Long-Term Survival
Tomasz Plonek1, Dominik Mendyka1,2,3, Frank R Halfwerk1,4
1Department of Cardio-Thoracic Surgery, Thorax Centrum Twente, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, The Netherlands.
Insights
Total arterial off-pump coronary artery bypass grafting (CABG) using a no-touch aorta and left internal mammary artery-radial artery Y-graft offers safe and effective long-term survival for a wide range of patients, including the elderly.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- Off-pump CABG (OPCAB) avoids cardiopulmonary bypass, potentially reducing complications.
- Total arterial grafting aims for improved long-term patency compared to venous grafts.
Purpose of the Study:
- To evaluate the long-term survival of patients undergoing total arterial OPCAB using a specific Y-graft configuration.
- To assess the safety and efficacy of this technique across different age groups and risk profiles.
Main Methods:
- A cohort of 2174 patients undergoing isolated CABG between 2004 and 2021 were analyzed.
- The surgical technique involved no-touch aorta, total arterial OPCAB with a left internal mammary artery-radial artery Y-graft.
- Survival analysis was performed using Kaplan-Meier curves and Cox regression, stratified by age.
Main Results:
- In-hospital mortality was low (0.6%) with minimal stroke incidence.
- Overall 5-year survival was 90%, with rates from 98% (youngest) to 65% (oldest age groups).
- No significant differences in outcomes were observed between age groups regarding mortality and stroke.
Conclusions:
- No-touch aorta, total arterial OPCAB with LIMA-RA Y-graft is a safe and effective revascularization strategy.
- This approach demonstrates favorable long-term survival across a broad patient spectrum, including elderly individuals.
- The technique is suitable for all-comers undergoing isolated CABG, irrespective of preoperative risk.
Abstract:
Objectives: To assess the long-term survival outcomes of patients undergoing no-touch aorta, total arterial off-pump coronary artery bypass grafting (OPCAB) using a left internal mammary artery (LIMA)-radial artery (RA) Y-graft configuration. This approach was applied uniformly to all-comers undergoing isolated CABG between 2004 and 2021, irrespective of preoperative risk profile. Methods: We included all patients treated with total arterial OPCAB using the LIMA-RA Y-graft without additional concomitant procedures. Patients were stratified into five age groups (<50, 50-59, 60-69, 70-79, and >80 years). Survival at 5 years was analyzed using Kaplan-Meier curves and Cox regression analysis. Results: A total of 2174 patients were analyzed, with a median follow-up of 3266 days. In-hospital mortality was 0.6%, whereas postoperative stroke was 0.3% without residual trauma and 0.2% with residual trauma, respectively, without differences between age groups. The mean number of grafts per patient was 3.7, with no significant variation between age groups (p = 0.09). Overall, 5-year survival was 90% (n = 1767), ranging from 98% in the youngest group to 65% in the oldest (log-rank p < 0.0001). Conclusions: No-touch aorta, total arterial OPCAB using the LIMA-RA Y-graft is a safe and effective revascularization strategy for a broad spectrum of patients, including those with advanced age and comorbidities.
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