title: Total Arterial Revascularization: Achievable and Prognostically Effective-A Multicenter Analysis.
abstract: BACKGROUND
  Total arterial revascularization (TAR) is adopted to overcome late vein graft atherosclerosis, and occlusion. Uptake of TAR remains low despite reports suggesting superior survival. Previous studies primarily involved single sites and short-term follow-up. We report the influence of TAR on long-term survival in a large multicenter patient cohort.
  
  
  METHODS
  We reviewed 63,592 cases from an audited collaborative multicenter database. Of those, 34,181 consecutive patients undergoing first-time isolated coronary artery bypass (CABG) from 2001 to 2012 were studied. The data were linked to the National Death Index. We compared outcomes in patients who underwent TAR (n = 12,271) with outcomes in those who did not (n = 21,910). The influence of TAR on 10-year all-cause late mortality was assessed by propensity score analyses in 6,232 matched pairs.
  
  
  RESULTS
  The 30-day mortality was 0.8% (96/12,271) for TAR patients and 1.8% (398/21,910) for non-TAR patients (p < 0.001). Late mortality was 7.5% (918/12,271) for TAR patients and 8.9% (1,952/21,910) for non-TAR patients (p < 0.001). The mean follow-up time was 4.9 years. In the propensity-matched cohort, the perioperative mortality was 0.9% (53/6,232) for TAR patients versus 1.2% (76/6,232) for non-TAR patients (p < 0.001). Kaplan-Meier survival in the matched cohort at 1, 5, and 10 years was 97.2%, 91.3%, and 85.4% for TAR patients and 96.5%, 90.1%, and 81.2% for non-TAR patients (p < 0.001). Late mortality was 8.0% (n = 500) for TAR patients and 10.0% (n = 622) for non-TAR patients (p < 0.001). Stratified Cox proportional hazards models showed lower risk for all-cause late mortality in the TAR group (TAR:HR 0.80, 95% confidence interval 0.71 to 0.90, p < 0.001).
  
  
  CONCLUSIONS
  TAR is associated with low perioperative mortality and, importantly, improved long-term survival and could be used more liberally.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia; Department of Surgery, The University of Melbourne, Melbourne, Australia. Electronic address: james.tatoulis@mh.org.au.
authors.forename: James
authors.initials: J
authors.lastname: Tatoulis
authors.affiliation: Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Wynne
authors.affiliation: Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Skillington
authors.affiliation: Department of Surgery, The University of Melbourne, Melbourne, Australia.
authors.forename: Brian F
authors.initials: BF
authors.lastname: Buxton
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013249:Sternum / Q000473:pathology; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome