Importance of the third arterial graft in multiple arterial grafting strategies
Background: The long-term benefit of multiple arterial grafts for coronary artery bypass (CABG) is not clear. This protocol was elaborated to see if multiple arterial grafts would provide better long-term outcomes when compared with conventional strategies.
Methods: Prospective data was collected for 588 patients undergoing isolated CABG between 1985 and 1995. We analyzed long term survival and freedom from cardiac death. The analysis compared patients with BITA grafting receiving a right gastro-epiploic artery (RGEA) versus those receiving a saphenous vein graft (SVG) as a third conduit. Cox proportional hazards modelling was used to adjust for relevant confounders.
Results: The mean age was 59±9 years and 49% received BITA. Mean follow-up was 16.1±5.4 years. Multivariable analysis revealed in that patients receiving the RGEA as a third conduit had superior overall survival (HR, 0.46; P=0.015) and cardiac survival (HR, 0.20; P=0.005) compared to those receiving an SVG.
Conclusions: In our experience, the use of multiple arterial grafting is independently associated with superior outcomes. Furthermore, the use of a third arterial conduit targeted to the RCA should be considered to improve long-term survival.