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Title: Total arterial revascularization with internal thoracic and radial artery grafts in triple-vessel coronary artery disease is associated with improved survival.
Austin Authors: Buxton, Brian F ;Shi, William Y;Tatoulis, James;Fuller, John A;Rosalion, Alexander;Hayward, Philip A R
Affiliation: Victorian Heart Centre, Epworth Hospital, University of Melbourne, Melbourne, Australia
Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
Issue Date: 17-Jul-2014
Publication information: The Journal of Thoracic and Cardiovascular Surgery 2014; 148(4): 1238-43; discussion 1243-4
Abstract: 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.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.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).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.
Gov't Doc #: 25131165
DOI: 10.1016/j.jtcvs.2014.06.056
Journal: The Journal of thoracic and cardiovascular surgery
Type: Journal Article
Subjects: Aged
Aged, 80 and over
Coronary Artery Bypass
Coronary Artery
Hospital Mortality
Internal Mammary-Coronary Artery Anastomosis.methods.mortality
Mammary Arteries.transplantation
Middle Aged
Myocardial Revascularization.methods.mortality
Propensity Score
Radial Artery.transplantation
Risk Factors
Appears in Collections:Journal articles

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