Long-Term Outcomes Following Off-pump Coronary Artery Bypass Grafting Using Only 3 In situ Arterial Grafts

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.