title: Total arterial grafting is associated with improved clinical outcomes compared to conventional myocardial revascularization at 10 years follow-up.
abstract: The use of arterial conduits is associated with incremental benefits when compared to conventional CABG surgery, albeit there is a paucity of data regarding the long-term outcomes of either techniques. Among 973 consecutive patients undergoing CABG, a propensity-match study was performed to compare total arterial revascularization technique (G1) with a conventional approach (LITA on LAD plus additional SVGs, G2). The study population was propensity-matched based on preoperative characteristics (age, sex, risk factors). Mean number of grafted vessels (G1 = 2.39 ± 0.55 vs G2 = 2.37 ± 0.7; p = 0.79) and aortic cross-clamp time (G1 = 36 ± 6 vs G2 = 35 ± 6 min; p = 0.31) were similar while CPB time was significantly longer in Group 2 (G1 = 50 ± 7 vs G2 = 70 ± 8 min; p = 0.03). Hospital mortality (G1 = 0.6 % vs G2 = 1.3 %; p = 0.41) and overall incidence of postoperative complications were also comparable. Cox regression analysis depicted conventional CABG as an independent predictor for MACCEs (HR = 4.53, CI 95 % = 2-10.28; p < 0.001). Median follow-up time was 112 months: actuarial survival free from cardiac death (G1 = 100 % vs G2 = 95 ± 2.1 %; p = 0.046) and MACCEs (G1 = 97.3 ± 1.5 % vs G2 = 79.4 ± 3.8 %; p < 0.001) was significantly improved in patients undergoing total arterial grafting. Total arterial myocardial revascularization is associated with significantly improved outcomes at 10 years follow-up in terms of cardiac-related mortality and overall event-free survival.
authors.affiliation: Division of Cardiac Surgery, University of Brescia Medical School, P.le Spedali Civili, 1, Brescia, 25123, Italy. gianluigi.bisleri@gmail.com.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Bisleri
authors.affiliation: Division of Cardiac Surgery, University of Brescia Medical School, P.le Spedali Civili, 1, Brescia, 25123, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Di Bacco
authors.affiliation: Division of Cardiac Surgery, University of Brescia Medical School, P.le Spedali Civili, 1, Brescia, 25123, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Giroletti
authors.affiliation: Division of Cardiac Surgery, University of Brescia Medical School, P.le Spedali Civili, 1, Brescia, 25123, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Muneretto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score; D012044:Regression Analysis; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Arterial conduits; Coronary artery bypass grafting; Long-term outcomes; Saphenous veins