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Published on: November 24, 2014
Long-Term Outcomes Following Off-pump Coronary Artery Bypass Grafting Using Only 3 In situ Arterial Grafts
Hiroshi Niinami1, Yuki Endo1, Kozo Morita1
1Department of Cardiovascular Surgery, Tokyo Women's Medical University Hospital, Tokyo 162-8666, Japan.
Insights
Off-pump coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) and right gastroepiploic artery (rGEA) grafts shows excellent early patency and long-term survival. This surgical approach offers a promising option for patients with multivessel disease.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for multivessel coronary artery disease.
- Bilateral internal thoracic artery (BITA) grafts are known for superior long-term patency.
- The use of right gastroepiploic artery (rGEA) as an additional in situ graft in CABG requires further evaluation.
Purpose of the Study:
- To evaluate the early angiographic patency and long-term clinical outcomes of off-pump CABG (OPCAB).
- To assess the safety and efficacy of using only in situ BITA and rGEA grafts.
- To determine the association of diabetes mellitus with outcomes in patients undergoing OPCAB with these grafts.
Main Methods:
- Retrospective analysis of patients undergoing OPCAB using only in situ skeletonized BITA and rGEA grafts from July 2007 to March 2019.
- Primary outcome: all-cause mortality.
- Secondary outcomes: early graft patency and major adverse cardiac and cerebral events (MACCE).
Main Results:
- 302 patients with triple-vessel disease underwent OPCAB with BITA/rGEA grafts.
- Early graft patency rate was 98.9%.
- Long-term follow-up (median 9.3 years) showed 5, 10, and 12-year survival rates of 92.6%, 85.7%, and 77.7%, respectively. MACCE-free survival rates were 89.6%, 79.9%, and 69.2%.
Conclusions:
- OPCAB using in situ BITA and rGEA grafts achieves excellent early patency and favorable long-term outcomes.
- The criteria for rGEA use in this study may contribute to improved long-term results in CABG.
- Diabetes mellitus was not significantly associated with mortality or MACCE in this cohort.
Objectives:
Coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) conduits can achieve good outcomes for multivessel lesions. This study evaluated early angiographic patency and outcomes following off-pump CABG (OPCAB) using only in situ BITA and right gastroepiploic artery (rGEA) grafts.
Methods:
This retrospective analysis included patients undergoing OPCAB using only in situ skeletonized BITA and rGEA grafts (July 2007 to March 2019). The primary outcome was all-cause mortality. Secondary outcomes were early graft patency and major adverse cardiac and cerebral events (MACCE).
Results:
During the study period, OPCAB using only in situ skeletonized BITA/rGEA grafts was performed in 302 of 1034 patients with triple-vessel disease (29.2%). The number of reconstructed branches was 4 [3-4] per patient. Median follow-up duration was 9.3 [6.6-11.8] years. No deaths occurred during the 30-day postoperative period, whereas 43 deaths (14.3%), including 11 cardiovascular-related deaths (3.6%), occurred during long-term follow-up. MACCE occurred in only 1 patient during the 30-day postoperative period and in 62 patients (20.2%) during long-term follow-up. Early graft patency rate after surgery was 98.9%. Estimated overall survival rates at 5, 10, and 12 years of follow-up were 92.6%, 85.7%, and 77.7%, respectively. Corresponding values for MACCE-free survival were 89.6%, 79.9%, and 69.2%. Diabetes mellitus was not significantly associated with all-cause mortality or MACCE.
Conclusions:
OPCAB using only in situ skeletonized BITA and rGEA grafts achieved excellent early angiographic patency and long-term outcomes, suggesting that applying our criteria for rGEA use might help improve the long-term outcomes of CABG.
