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Thorac Cardiovasc Surg 2023; 71(06): 434-440
DOI: 10.1055/s-0042-1745805
Original Cardiovascular

Impact of Second Arterial Conduit on Outcomes Following Coronary Bypass Grafting

Sleiman Sebastian Aboul-Hassan 
1   Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland
2   Department of Cardiac Surgery and Interventional Cardiology, Medical University of Zielona Gora, Zielona Gora, Poland
3   Department of Medicine and Medical Sciences, Medical University of Zielona Gora, Zielona Gora, Poland
,
Jakub Marczak
4   Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, United Kingdom
,
Tomasz Stankowski
5   Department of Cardiac Surgery, Sana-Heart Center Cottbus, Cottbus, Germany
,
Lukasz Moskal
6   Department of Cardiac Surgery, MEDINET Heart Center Ltd, Wroclaw, Poland
,
Ryszard Stanislawski
1   Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland
,
Bartlomiej Perek
7   Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
,
Romuald Cichon
1   Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland
2   Department of Cardiac Surgery and Interventional Cardiology, Medical University of Zielona Gora, Zielona Gora, Poland
3   Department of Medicine and Medical Sciences, Medical University of Zielona Gora, Zielona Gora, Poland
6   Department of Cardiac Surgery, MEDINET Heart Center Ltd, Wroclaw, Poland
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Abstract

Background The aim of this study was to compare short-term outcomes and long-term survival in patients following coronary artery bypass grafting in whom second arterial conduit or saphenous vein was used as well as to find out the most optimal second arterial graft.

Methods Between January 2006 and June 2018, 7,857 patients met the inclusion criteria and were divided into two groups: single internal thoracic artery (SITA) + Vein group (n = 7,140) and second arterial conduit group (n = 717), of these 537 patients received right internal thoracic artery (RITA) and 180 patients received radial artery (RA). We obtained 701 propensity-matched pairs for final comparison. Short-term outcomes included: 30-day mortality and major adverse cardiac and cerebral events (MACCE), reoperation for bleeding, and deep sternal wound infection (DSWI). The long-term outcome was all-cause mortality.

Results No significant differences were observed between second arterial conduit versus SITA + Vein groups and between RITA versus RA groups in terms of 30-day mortality, 30-day MACCE, reoperation for bleeding, and incidence of DSWI in the matched cohort. The use of second arterial conduit was associated with a significant reduction in long-term mortality by 24% in the matched cohort (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.60–0.96; p = 0.02). RA and RITA as second arterial conduit had comparable long-term mortality (HR: 1.12; 95% CI: 0.69–1.82; p = 0.62).

Conclusion The use of second arterial conduit, irrespective of type, is safe and associated with improved long-term survival compared with the second venous aortocoronary graft.

Keywords

coronary bypass grafting - arterial grafting - mortality - outcomes


Publication History

Received: 01 December 2021

Accepted: 21 February 2022

Article published online:
28 May 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Loop FD, Lytle BW, Cosgrove DM. et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 1986; 314 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 2 Goldman S, Zadina K, Moritz T. et al; VA Cooperative Study Group #207/297/364. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol 2004; 44 (11) 2149-2156
    CrossrefPubMedGoogle Scholar
  • 3 Sabik III JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM. Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. Ann Thorac Surg 2005; 79 (02) 544-551 , discussion 544–551
    CrossrefPubMedGoogle Scholar
  • 4 Taggart DP, D'Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet 2001; 358 (9285): 870-875
    CrossrefPubMedGoogle Scholar
  • 5 Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM. The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Ann Thorac Surg 2004; 78 (06) 2005-2012 , discussion 2012–2014
    CrossrefPubMedGoogle Scholar
  • 6 Benedetto U, Amrani M, Gaer J. et al; Harefield Cardiac Outcomes Research Group. The influence of bilateral internal mammary arteries on short- and long-term outcomes: a propensity score matching in accordance with current recommendations. J Thorac Cardiovasc Surg 2014; 148 (06) 2699-2705
    CrossrefPubMedGoogle Scholar
  • 7 Gaudino M, Benedetto U, Fremes S. et al; RADIAL Investigators. Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery. N Engl J Med 2018; 378 (22) 2069-2077
    CrossrefPubMedGoogle Scholar
  • 8 Gaudino M, Lorusso R, Rahouma M. et al. Radial artery versus right internal thoracic artery versus saphenous vein as the second conduit for coronary artery bypass surgery: a network meta-analysis of clinical outcomes. J Am Heart Assoc 2019; 8 (02) e010839
    CrossrefPubMedGoogle Scholar
  • 9 Tabata M, Grab JD, Khalpey Z. et al. Prevalence and variability of internal mammary artery graft use in contemporary multivessel coronary artery bypass graft surgery: analysis of the Society of Thoracic Surgeons National Cardiac Database. Circulation 2009; 120 (11) 935-940
    CrossrefPubMedGoogle Scholar
  • 10 Parasca CA, Head SJ, Mohr FW. et al; SYNTAX Investigators. The impact of a second arterial graft on 5-year outcomes after coronary artery bypass grafting in the synergy between percutaneous coronary intervention with TAXUS and Cardiac Surgery Trial and Registry. J Thorac Cardiovasc Surg 2015; 150 (03) 597-606 .e2
    CrossrefPubMedGoogle Scholar
  • 11 Taggart DP, Benedetto U, Gerry S. et al; Arterial Revascularization Trial Investigators. Bilateral versus single internal-thoracic artery grafts at 10 years. N Engl J Med 2019; 380 (05) 437-446
    CrossrefPubMedGoogle Scholar
  • 12 Taggart DP, Altman DG, Gray AM. et al; ART Investigators. Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). Eur Heart J 2010; 31 (20) 2470-2481
    CrossrefPubMedGoogle Scholar
  • 13 Vandenbroucke JP, von Elm E, Altman DG. et al; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 2014; 12 (12) 1500-1524
    CrossrefPubMedGoogle Scholar
  • 14 Thygesen K, Alpert JS, Jaffe AS. et al; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol 2018; 72 (18) 2231-2264
    CrossrefPubMedGoogle Scholar
  • 15 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Guideline for Prevention of Surgical Site Infection, 1999. Am J Infect Control 1999; 27 (02) 97-132 , quiz 133–134, discussion 96
    CrossrefPubMedGoogle Scholar
  • 16 Lauer MS, Blackstone EH, Young JB, Topol EJ. Cause of death in clinical research: time for a reassessment?. J Am Coll Cardiol 1999; 34 (03) 618-620
    CrossrefPubMedGoogle Scholar
  • 17 Benedetto U, Head SJ, Angelini GD, Blackstone EH. Statistical primer: propensity score matching and its alternatives. Eur J Cardiothorac Surg 2018; 53 (06) 1112-1117
    CrossrefPubMedGoogle Scholar
  • 18 Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 2011; 10 (02) 150-161
    CrossrefPubMedGoogle Scholar
  • 19 Austin PC. Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score. Am J Epidemiol 2010; 172 (09) 1092-1097
    CrossrefPubMedGoogle Scholar
  • 20 Chikwe J, Sun E, Hannan EL. et al. Outcomes of second arterial conduits in patients undergoing multivessel coronary artery bypass graft surgery. J Am Coll Cardiol 2019; 74 (18) 2238-2248
    CrossrefPubMedGoogle Scholar
  • 21 Schwann TA, Hashim SW, Badour S. et al. Equipoise between radial artery and right internal thoracic artery as the second arterial conduit in left internal thoracic artery-based coronary artery bypass graft surgery: a multi-institutional study. Eur J Cardiothorac Surg 2016; 49 (01) 188-195
    CrossrefPubMedGoogle Scholar
  • 22 Shi WY, Hayward PA, Tatoulis J. et al. Are all forms of total arterial revascularization equal? A comparison of single versus bilateral internal thoracic artery grafting strategies. J Thorac Cardiovasc Surg 2015; 150 (06) 1526-1533 , 1534.e1–1534.e3, discussion 1533–1534
    CrossrefPubMedGoogle Scholar
  • 23 Benedetto U, Caputo M, Gaudino M. et al. Right internal thoracic artery or radial artery? A propensity-matched comparison on the second-best arterial conduit. J Thorac Cardiovasc Surg 2017; 153 (01) 79-88 .e4
    CrossrefPubMedGoogle Scholar
  • 24 Buxton BF, Hayward PA, Raman J. et al; RAPCO Investigators*. Long-term results of the RAPCO trials. Circulation 2020; 142 (14) 1330-1338
    CrossrefPubMedGoogle Scholar
  • 25 Benedetto U, Altman DG, Gerry S. et al; Arterial Revascularization Trial investigators. Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: insights from the Arterial Revascularization Trial. J Thorac Cardiovasc Surg 2016; 152 (01) 270-276
    CrossrefPubMedGoogle Scholar
  • 26 Gaudino M, Alexander JH, Bakaeen FG. et al. Randomized comparison of the clinical outcome of single versus multiple arterial grafts: the ROMA trial-rationale and study protocol. Eur J Cardiothorac Surg 2017; 52 (06) 1031-1040
    CrossrefPubMedGoogle Scholar