Multiple arterial grafts for total arterial coronary artery bypass grafting vs. the conventional approach

Tarek Omran; Ashraf Zahra

Tarek Omran Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
Ashraf Zahra Department of Cardiothoracic Surgery, Shebin El-Kom Teaching Hospital, Menoufia, Egypt

Keywords: Coronary artery bypass grafting, Total arterial revascularization, Radial artery, Internal mammary artery

Abstract

Background: Conduit choice for coronary artery bypass grafting (CABG) is a hot topic. The objectives of this study were to characterize the patients who received multiple arterial grafts vs. vein grafts; additionally, we compared the outcomes in those patients.

Methods: This retrospective study included 195 consecutive patients who underwent CABG. We grouped the patients into three groups according to the conduits used with the left internal mammary artery (LIMA). Group I had saphenous vein grafts (SVG) (n= 31), Group II had radial artery grafts (RA) (n= 86), and Group III had the bilateral internal mammary artery (BIMA) plus RA (n= 78).

Results: The patients with multiple arterial grafts were significantly younger (64.87±8.2 vs. 68.42±9.03 vs. 61.76±8.6 years, in the SVG, LIMA_RA, and BIMA+RA groups, respectively, P<0.001). Off-pump surgery was significantly more prevalent in patients with LIMA+RA (P= 0.01). Postoperative drainage was significantly higher in patients with BIMA+ RA compared to LIMA+RA (P= 0.006), with no significant difference between BIMA+ RA and LIMA+SVG (P= 0.081). Sternal wound infection was non-significantly higher with multiple arterial grafts (P=0.09). There was no difference in other hospital outcomes among groups. The median follow-up was 59 (47-66) months. The composite endpoint of recurrent angina, myocardial infarction, coronary revascularization, and heart failure occurred in 17 patients [4 (12.9%) vs. 8 (9.30%) vs. 5 (6.41%), in the vein graft, one arterial and two arterial grafts groups, respectively] (P=0.484). Mortality occurred in 7 patients, [1 (3.23%) vs. 4 (4.65%) vs. 2 (2.56%), in the vein graft, one arterial, and two arterial grafts groups, respectively] (P= 0.834).

Conclusions: Total arterial revascularization with multiple arterial grafts could increase postoperative drainage and sternal wound infection, with no difference in the short and long-term outcomes compared to single arterial and vein grafts. The choice of the conduit for coronary artery bypass grafting should be tailored according to the patient's characteristics.