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Published on: March 27, 2018
Single Versus Multiple Inflow Source for Coronary Artery Bypass Surgery in Ischemic Cardiomyopathy
Sung Jun Park1, Kyung-Jong Yoo1, Young-Nam Youn2
1Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Yonsei University Health System, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
Coronary artery bypass grafting (CABG) using multiple inflow sources improves survival in ischemic cardiomyopathy patients. Multiple grafts offer better long-term outcomes compared to single grafts, especially without recent heart injury.
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.
Background And Objectives:
The optimal grafting strategy for ischemic cardiomyopathy (ICMP) remains uncertain despite the growing heart failure population undergoing coronary artery bypass grafting (CABG). This study sought to explore the outcomes of CABG in ICMP patients according to the number of inflow sources.
Methods:
A total of 447 patients with an ejection fraction (EF) of ≤35% who underwent isolated CABG from 2009 to 2020 were analyzed. Patients were categorized into either a single inflow source group (single group, n=203), in which unilateral in situ internal thoracic artery (ITA) served as the sole inflow, or a multiple inflow source group (multiple group, n=244), utilizing additional inflow sources from the aorta or contralateral ITA. The primary outcome was all-cause mortality, analyzed after adjustment using the inverse-probability-of-treatment-weighting method.
Results:
There were no differences in the early outcomes between 2 groups. After adjustment, the single group exhibited significantly worse survival compared to the multiple group during a median follow-up of 5.3-years (adjusted hazard ratio, 1.88; 95% confidence interval, 1.26-2.80; p=0.001), particularly in the subgroup of patients without a recent myocardial infarction within 1 month (p=0.005) and those with an EF of ≥25% (p=0.007). At the last follow-up echocardiography (>6 months), the multiple group showed a significantly higher postoperative EF (p=0.009) and a smaller left ventricular end-systolic dimension (p=0.027) compared to the single group, which had not shown significant differences preoperatively.
Conclusions:
In ICMP patients, CABG using multiple inflow sources was associated with improved outcomes, particularly in those without recent or profound myocardial injury.
