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Does Total Arterial Revascularisation Confer a Survival Advantage in Moderate Left Ventricular Dysfunction? A
Albaraa Al-Holy1, Nandor Marczin2, Sunil K Bhudia1
1Department of Cardiac Surgery, Harefield Hospital, London UB9 6JH, UK.
Insights
Total arterial grafting (TAG) is safe for coronary artery bypass grafting (CABG) in patients with moderate left ventricular dysfunction. While not statistically superior, TAG showed comparable short-term outcomes and no independent association with long-term mortality compared to single arterial grafting (SAG).
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Arterial Grafting Techniques
Background:
- Coronary artery bypass grafting (CABG) in patients with moderate left ventricular dysfunction (LVEF 30-49%) presents unique challenges.
- The optimal conduit strategy, particularly comparing total arterial grafting (TAG) versus single arterial grafting (SAG), remains debated in this higher-risk subgroup.
Purpose of the Study:
- To compare short-term outcomes and long-term survival between TAG and SAG in patients with moderate left ventricular dysfunction undergoing isolated CABG.
- To evaluate the safety and feasibility of TAG in this specific patient population.
Main Methods:
- Retrospective analysis of 1866 patients undergoing CABG.
- Propensity score matching of 640 patients (320 SAG vs. 320 TAG) to balance baseline characteristics.
- Assessment of preoperative, intraoperative, and postoperative variables; long-term survival evaluated using Kaplan-Meier analysis and Cox regression.
Main Results:
- Matched cohorts demonstrated well-balanced baseline characteristics.
- Long-term survival at 10 and 15 years was numerically higher in the TAG group but not statistically significant (log-rank p = 0.862).
- Grafting strategy (TAG vs. SAG) was not independently associated with long-term mortality (HR 1.005, p = 0.966) in multivariate analysis.
Conclusions:
- Total arterial grafting (TAG) is a safe and feasible option for isolated CABG in patients with moderate left ventricular dysfunction.
- Short-term outcomes were comparable between TAG and SAG.
- Despite numerical trends, propensity matching and multivariable adjustment revealed no independent association between grafting strategy and long-term mortality.
Objectives:
The optimal conduit strategy for coronary artery bypass grafting (CABG) in patients with moderate left ventricular dysfunction (LVEF 30-49%) remains debated. While total arterial grafting (TAG) has shown benefits in broader populations, its role in this higher-risk subgroup is unclear. This study aimed to compare short-term outcomes and long-term survival between single arterial grafting (SAG) and TAG in patients with moderate LV dysfunction undergoing CABG.
Methods:
A retrospective analysis of 1866 patients was performed, with 640 patients matched using propensity scores (320 SAG vs. 320 TAG). Preoperative, intraoperative, and postoperative variables were assessed. Survival was evaluated using Kaplan-Meier analysis and Cox regression.
Results:
Matched cohorts were well balanced across baseline characteristics. Long-term survival at 10 and 15 years was numerically higher in the TAG group (85.8% and 79.7%) compared to SAG (81.7% and 74.2%), though not statistically significant (log-rank p = 0.862). Multivariate Cox regression identified age (HR 1.045, p < 0.001), NYHA class (NYHA III HR 0.610, p = 0.003), previous cardiac surgery (HR 0.501, p = 0.006), and off-pump CABG (HR 1.521, p < 0.001) as independent predictors of mortality. Grafting strategy (TAG vs. SAG) was not independently associated with long-term mortality (HR 1.005, p = 0.966).
Conclusion:
TAG is safe and feasible in patients with moderate LV dysfunction undergoing isolated CABG, with comparable short-term outcomes. Although unadjusted analyses suggested improved long-term survival, this difference was not observed after propensity matching or multivariable adjustment, and grafting strategy was not independently associated with mortality.
