Y-Graft Versus In Situ Bilateral Internal Mammary Arteries in Endoscopic Coronary Artery Bypass Grafting

The clinical outcomes of bilateral internal mammary arteries (BIMA) in situ were compared with Y-grafts in endoscopic coronary artery bypass grafting (endo-CABG), a less-invasive alternative to conventional CABG, providing reduced trauma and faster recovery.

A retrospective single-center study was performed from January 2016 until February 2023 on endo-CABG patients, dividing them into in situ BIMA graft or Y-graft recipients. As endo-CABG was performed in all patients requiring surgical revascularization, this represents an unselected cohort. The primary outcome comprised freedom from major adverse cardiac and cerebrovascular events (MACCE). The secondary outcomes were target lesion revascularization (TLR) and 1-year overall survival.

A total of 1,328 endo-CABG patients (BIMA in situ, n = 693; Y-graft, n = 634) were included. Overall, characteristics of both groups were comparable, except that Y-graft patients had more comorbidities (diabetes mellitus and myocardial infarction), which was reflected in the EuroSCORE II. Furthermore, most Y-graft patients had triple-vessel disease and a higher number of bypasses required. The 1-year MACCE-free survival did not differ significantly between the groups (91.9% vs 89%; univariable hazard ratio [HR] = 1.42, 95% CI: 0.96 to 2.11, P = 0.079; multivariable HR = 1.07, 95% CI: 0.70 to 1.63, P = 0.771), as did the 1-year survival rate (95.7% vs 93.2%; univariable HR = 1.67, 95% CI: 1.01 to 2.75, P = 0.046; multivariable HR =1.34, 95% CI: 0.77 to 2.33, P = 0.297). TLR did not differ significantly between groups (univariable HR = 0.68, 95% CI: 0.22 to 2.08, P = 0.499) or after adjustment (multivariable HR = 0.31, 95% CI: 0.08 to 1.24, P = 0.100).

Creating a Y-graft for distal lesions and in cases in which more than 2 anastomoses are required serves as a favorable alternative without a difference between in situ and Y-grafts in 1-year MACCE-free survival.