Secondary Conduits in Coronary Artery Bypass Surgery.

Journal

The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R

Informations de publication

Date de publication:
23 Aug 2024
Historique:
received: 21 09 2023
revised: 20 06 2024
accepted: 16 07 2024
medline: 26 8 2024
pubmed: 26 8 2024
entrez: 25 8 2024
Statut: aheadofprint

Résumé

Recent evidence has suggested use of the right internal mammary artery (RIMA) is associated with worse clinical outcomes in patients undergoing coronary artery bypass graft (CABG) surgery. Therefore, we compared the clinical consequences of secondary conduit selection (RIMA vs radial artery vs saphenous vein) after CABG. A post hoc analysis of the CABG Off or On Pump Revascularization Study, involving 3913 patients from 79 centers in 19 countries who underwent CABG surgery and received arterial grafting with at least 2 grafts. Outcomes of interest were all-cause mortality, myocardial infarction, stroke, and revascularization. A total of 3913 patients received veins (3210 [68%]), radial arteries (549 [12%]), or RIMAs (154 [3%]) to supplement left internal mammary artery to left anterior descending artery grafts. The risk of all-cause mortality was reduced in patients who received secondary radial arteries compared with veins (weighted hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.64 to 0.98) and increased in patients who received RIMA compared with veins (weighted HR, 1.37; 95% CI, 1.13-1.68) after 4.8 years of follow-up. Multiple and single arterial grafting had a similar mortality risk (weighted HR, 0.87; 95% CI, 0.73 to 1.03). Supplementing left internal mammary artery to left anterior descending artery grafting using radial arteries led to better clinical outcomes than veins, and too few RIMA were available to draw definitive conclusions. A randomized trial is needed to clarify the role of the RIMA in multiple arterial grafting CABG surgery.

Sections du résumé

BACKGROUND BACKGROUND
Recent evidence has suggested use of the right internal mammary artery (RIMA) is associated with worse clinical outcomes in patients undergoing coronary artery bypass graft (CABG) surgery. Therefore, we compared the clinical consequences of secondary conduit selection (RIMA vs radial artery vs saphenous vein) after CABG.
METHODS METHODS
A post hoc analysis of the CABG Off or On Pump Revascularization Study, involving 3913 patients from 79 centers in 19 countries who underwent CABG surgery and received arterial grafting with at least 2 grafts. Outcomes of interest were all-cause mortality, myocardial infarction, stroke, and revascularization.
RESULTS RESULTS
A total of 3913 patients received veins (3210 [68%]), radial arteries (549 [12%]), or RIMAs (154 [3%]) to supplement left internal mammary artery to left anterior descending artery grafts. The risk of all-cause mortality was reduced in patients who received secondary radial arteries compared with veins (weighted hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.64 to 0.98) and increased in patients who received RIMA compared with veins (weighted HR, 1.37; 95% CI, 1.13-1.68) after 4.8 years of follow-up. Multiple and single arterial grafting had a similar mortality risk (weighted HR, 0.87; 95% CI, 0.73 to 1.03).
CONCLUSIONS CONCLUSIONS
Supplementing left internal mammary artery to left anterior descending artery grafting using radial arteries led to better clinical outcomes than veins, and too few RIMA were available to draw definitive conclusions. A randomized trial is needed to clarify the role of the RIMA in multiple arterial grafting CABG surgery.

Identifiants

DOI: 10.1016/j.athoracsur.2024.07.044 PMID: 39182556
pubmed: 39182556
pii: S0003-4975(24)00682-9
doi: 10.1016/j.athoracsur.2024.07.044
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Austin Browne (A)

Population Health Research Institute and Hamilton Health Sciences, Hamilton, Ontario, Canada.

Shun Fu Lee (SF)

Population Health Research Institute and Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.

Fraser Rubens (F)

Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.

Xiangbin Pan (X)

Department of Structural Heart Disease, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Nicolas Noiseux (N)

Department of Cardiac Surgery, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada.

Mario Gaudino (M)

Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.

Arnaldo Dimagli (A)

Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK.

André Lamy (A)

Population Health Research Institute and Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Electronic address: lamya@mcmaster.ca.

Classifications MeSH