Does Graft Selection Other Than ITA-LAD in Coronary Artery Bypass Grafting Affect Long-term Outcome?

Shinya Takase, Hirono Satokawa, Hiroki Wakamatsu, Hiroyuki Kurosawa, Yuki Seto, Akihiro Yamamoto, Tsuyoshi Fujimiya, Keiichi Ishida, Satomi Matsumoto, Hitoshi Yokoyama

Fukushima Medical University, School of Medicine, Fukushima, Japan

Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–A

Abstract

Objective; Internal thoracic artery (ITA) to left anterior descending artery (LAD) is highly recommended in coronary artery bypass surgery. However, second and third graft selection is in controversial. This paper is to investigate whether graft selection other than ITA-LAD affects long-term outcome after CABG.

Method; Between 2001 and 2014, 202 patients (male:female=165:37, 68+-9 yo) who had off-pump coronary bypass (OPCAB) surgery with more than 3 distal anastomosis were analyzed. Those patients were divided into 3 groups, all arterial graft group (All_A;n=147), 2 arterial and 1 vein graft group (2A+V;n=57), or 1 arterial and vein graft (1A+V;n=42) group. Those groups were compared in early and long-term result (all-cause death, cardiac death, major adverse cardio-cerebral events (MACCE)).

Results; Mean number of anastomosis was 3.3 sites under using more than 3 graft conduits. First of all, comparing ITA used group and non ITA used group, at 10 years after surgery, ITA-LAD group is superior in 90% in survival to non ITA-LAD group in 85%. Perioperatively, there was no difference among All_A, 2A+V, and 1A+V groups. The survival at 10 years in All_A group is better tendency but not significant. However, All_A and 2A+V groups were significantly better in cardiac death and MACCE than 1A+V group.

Conclusion; Eventually, in CABG surgery required multiple grafting, choosing two and more arterial grafts including ITA could be important to achieve better long-term result, but the third graft selection may not affect final result especially in survival.