Single Versus Multiple Inflow Source for Coronary Artery Bypass Surgery in Ischemic Cardiomyopathy.

Area of Science:

• Cardiovascular Surgery
• Heart Failure Research
• Myocardial Revascularization

Background:

• Optimal coronary artery bypass grafting (CABG) strategy for ischemic cardiomyopathy (ICMP) is unclear.
• Growing heart failure population undergoes CABG.
• Grafting strategy impacts outcomes in ICMP patients.

Purpose of the Study:

• To explore CABG outcomes in ICMP patients based on the number of inflow sources.
• To compare survival rates between single and multiple inflow source grafting.
• To identify factors influencing graft strategy effectiveness in ICMP.

Main Methods:

• Analysis of 447 ICMP patients undergoing isolated CABG (2009-2020).
• Categorization into single (unilateral internal thoracic artery) or multiple inflow source groups.
• Primary outcome: all-cause mortality, adjusted using inverse-probability-of-treatment-weighting.

Main Results:

• No early outcome differences between groups.
• Multiple inflow sources associated with significantly better survival (adjusted HR, 1.88; p=0.001) over 5.3 years.
• Improved survival with multiple sources noted in patients without recent myocardial infarction and EF ≥25%.

Conclusions:

• CABG with multiple inflow sources improves outcomes in ICMP patients.
• Multiple inflow sources are particularly beneficial in patients without recent or profound myocardial injury.
• This strategy enhances long-term survival and cardiac function post-CABG.