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J Thorac Cardiovasc Surg. 2014 Oct;148(4):1238-43; discussion 1243-4. doi: 10.1016/j.jtcvs.2014.06.056. Epub 2014 Jul 17.

Total arterial revascularization with internal thoracic and radial artery grafts in triple-vessel coronary artery disease is associated with improved survival.

Author information

1
Victorian Heart Centre, Epworth Hospital, University of Melbourne, Melbourne, Australia; Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia. Electronic address: brianbuxton40@gmail.com.
2
Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia.
3
Victorian Heart Centre, Epworth Hospital, University of Melbourne, Melbourne, Australia; Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia.
4
Victorian Heart Centre, Epworth Hospital, University of Melbourne, Melbourne, Australia.
5
Victorian Heart Centre, Epworth Hospital, University of Melbourne, Melbourne, Australia; Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia.

Abstract

OBJECTIVES:

We sought to evaluate our experience with total arterial revascularization and compare it with the traditional approach of a single internal thoracic artery supplemented by saphenous veins.

METHODS:

From 1995 to 2010, 6059 patients with triple-vessel coronary artery disease underwent primary isolated coronary artery bypass grafting at 8 centers. A study cohort of 3774 patients was formed, with 2988 (79%) undergoing total arterial revascularization and 786 (21%) receiving only saphenous veins to supplement a single in situ internal thoracic artery. In the total arterial revascularization group, bilateral internal thoracic arteries were used in 1079 patients (36%) and at least 1 radial artery was used in 2916 patients (97%). Propensity score matching was used for risk adjustment.

RESULTS:

Patients undergoing total arterial revascularization were younger (65.0±10.4 years vs 71.3±7.9 years, P<.001) and less likely to have diabetes, cerebrovascular disease, recent myocardial infarction, and severe left ventricular impairment. At 15 years, patients who underwent total arterial revascularization experienced superior unadjusted survival (62%±1.1% vs 35%±1.9%, P<.001). Multivariable Cox regression in the entire study cohort showed the total arterial group had improved survival with a hazard ratio of 0.79 (95% confidence interval, 0.70-0.90; P<.001). After propensity score matching yielded 384 patient pairs, patients who underwent total arterial revascularization showed improved survival at 15 years than patients who underwent single arterial revascularization (54%±3.3% vs 41%±3.0%, P=.0004).

CONCLUSIONS:

This large multicenter study suggests that a strategy of total arterial revascularization is associated with improved long-term survival compared with the use of only a single arterial and saphenous vein grafts. Total arterial revascularization should be encouraged in patients with a reasonable life expectancy.

PMID:
25131165
DOI:
10.1016/j.jtcvs.2014.06.056
[Indexed for MEDLINE]
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