Is composite T-grafting in total arterial revascularisation safe when four or more coronary vessels are grafted?

Objective: Total arterial revascularisation (TAR) can be achieved with only two grafts when composite T-grafting is performed. It has been suggested, that the single inflow into composite arterial grafts is a risk factor for postoperative myocardial ischemia due to unmet flow demand of the peripheral coronary vessels. This may be especially true, when four or more coronary anastomoses are performed.

Methods: We reviewed the data of 729 consecutive patients (89% male, age: 62±9y) who underwent T-grafting for multi-vessel CAD between 2001 and 2008 in our institution. We compared the early postoperative outcome of patients receiving more than three distal anastomoses (group A, n=209) and three anastomoses or less (group B; n=520). Endpoints were 30d-mortality, incidence of myocardial infarction (MI) and low cardiac output. Additionally, logistic regression analysis was performed to reveal independent risk factors for adverse outcome.

Results: Both groups were comparable regarding preoperative risk factors (Euroscore: group A 5.2% vs. group B 5.4%; P=0.81). Postoperative data did not show significant differences in complications such as MI (group A 1.9% vs. group B 1.7%, P=0.87) and low cardiac output (group A 2.5% vs. group B 1.9%, P=0.64). 30day-mortality was comparably low in both groups (group A 0.5% vs. group B 0.8%, P=0.67).

Conclusions: Total arterial revascularization with composite T-grafts can be achieved with extremely low complication rates irrespective of the number of distal anastomoses. The use of T-grafts can be recommended as a universal technique for the treatment of multivessel coronary artery disease in a wide range of patients.