title: The impact of placing multiple grafts to each myocardial territory on long-term survival after coronary artery bypass grafting.
abstract: OBJECTIVE
  Incomplete myocardial revascularization decreases survival for patients undergoing coronary artery bypass grafting. The effects of constructing multiple grafts to each major diseased artery territory are unknown. We aimed to determine the impact on long-term survival after coronary artery bypass grafting of placing multiple grafts to each myocardial territory.
  
  
  METHODS
  We reviewed data from 1129 consecutive patients who underwent coronary artery bypass grafting at our institution between 1997 and 2007 and compared outcomes between patients who received multiple grafts to each major diseased artery territory (n = 549) with those of patients who received single grafts to each territory (n = 580). We assessed long-term survival with Kaplan-Meier curves generated by log-rank tests, adjusting for confounding factors with Cox proportional hazards regression analysis.
  
  
  RESULTS
  Patients who received multiple grafts to each major diseased artery territory had longer cardiopulmonary bypass and aortic crossclamp times than patients who received single grafts per territory. Patient groups had similar early outcomes, including 30-day mortalities (1.3% vs 1.4%, P > .999) and incidences of major adverse cardiac events (2.9% vs 2.2%, P = .57). Cox regression 10-year survival curves were also similar between groups (adjusted hazard ratio 0.94, 95% confidence interval 0.67-1.34, P = .74).
  
  
  CONCLUSIONS
  Patients who received multiple grafts to each major diseased artery territory had early outcomes similar to those who received single grafts per territory. Constructing multiple grafts to each major diseased artery territory increases operative time and does not improve long-term survival.
authors.affiliation: Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX 77030, USA. dchumd@gmail.com
authors.forename: Danny
authors.initials: D
authors.lastname: Chu
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Bakaeen
authors.forename: Xing Li
authors.initials: XL
authors.lastname: Wang
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
authors.forename: Scott A
authors.initials: SA
authors.lastname: LeMaire
authors.forename: Joseph
authors.initials: J
authors.lastname: Huh
mesh_terms: D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors