Is Total Arterial Grafting Superior to Multiarterial Grafting in Coronary Bypass?
Dror B Leviner1, Tom Ronai2, Ely Erez3
1Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Israel.
Insights
Total arterial revascularization (TAR) did not show a benefit over multiple arterial grafting (MAG) for coronary artery bypass grafting (CABG) patients with multivessel disease. Midterm follow-up revealed similar major adverse cardiac and cerebrovascular events (MACCE) rates between TAR and MAG strategies.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Arterial Grafting Techniques
Background:
- Multiple arterial grafting (MAG) is linked to better long-term results in coronary artery bypass grafting (CABG).
- Data comparing total arterial revascularization (TAR) to MAG for multivessel disease are limited.
- Understanding the comparative efficacy of arterial grafting strategies is crucial for optimizing CABG outcomes.
Purpose of the Study:
- To compare the midterm efficacy of total arterial revascularization (TAR) versus multiple arterial grafting (MAG) in patients with multivessel disease undergoing isolated CABG.
- To evaluate the composite endpoint of major adverse cardiac and cerebrovascular events (MACCE) between TAR and MAG strategies.
- To assess differences in mortality rates between the two arterial grafting approaches.
Main Methods:
- Retrospective analysis of 2,791 adult patients with multivessel disease undergoing isolated CABG between 2009 and 2023.
- Patients were categorized into TAR (n=1,048) and MAG (n=1,743) groups.
- Kaplan-Meier curves and multivariate Cox models were used to compare MACCE and calculate hazard ratios (HR), with a median follow-up of 101 months.
Main Results:
- The cumulative incidence of MACCE was 48.57% in the TAR group and 42.4% in the MAG group.
- Multivariable analysis showed no significant difference in MACCE between TAR and MAG (HR: 1.05; 95% CI: 0.93-1.18; p=0.25).
- Mortality rates were higher in the TAR group (28.72%) compared to the MAG group (23.06%).
Conclusions:
- Total arterial revascularization (TAR) does not offer a significant advantage over multiple arterial grafting (MAG) in terms of midterm MACCE for patients with multivessel disease undergoing CABG.
- The observed trend suggests potentially higher mortality with TAR, warranting further investigation.
- Current evidence does not support the routine use of TAR over MAG for this patient population based on midterm outcomes.
Abstract:
Multiple arterial grafting (MAG) is associated with improved long-term outcomes. However, there are limited data on the benefit of total arterial revascularization (TAR).Retrospective study of adult patients with multivessel disease undergoing isolated coronary artery bypass grafting (CABG) in three centers between January 1, 2009, and December 31, 2023. Patients were grouped according to the revascularization strategy (TAR vs. MAG). The primary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE). The cumulative incidence of MACCE was plotted using Kaplan Meier (KM) curves. The hazard ratio (HR) for TAG versus MAG was calculated using multivariate Cox models.Our cohort included 2,791 patients. About 1,048 (37.55%) underwent TAR and 1,743 (62.45%) underwent MAG, of whom 2,434 (87.21%) were male. Mean age was 61.6 ± 9.8 years in the TAR and 62.1 ± 9.1 years in the MAG. Median follow-up time was 101 months. The cumulative incidence of the primary outcome was 48.57% in the TAR and 42.4% in the MAG group. After multivariable adjustment, TAR had an HR of 1.05, 95% CI (0.93-1.18) for the primary outcome (p = 0.25). The mortality rate was 28.72% in the TAR and 23.06% in the MAG group.TAR showed no benefit over MAG at midterm follow-up.
