Abstract 21279: A Randomised Controlled Trial Comparing Conventional Coronary Artery Bypass Graft Surgery with a Composite Arterial Graft Technique
Background: Composite (Y/T) coronary artery bypass graft surgery (CABG) confers full arterial revascularisation, and “hands off” aorta compared to conventional bypass graft surgery. However, the composite surgical configuration could lead to preferential blood flow down one arm than the other (left internal mammary artery LIMA or radial artery RA) with its potential impact on graft patency. Aim: to investigate the impact of bypass graft configuration on short-term grafts patency and cardiac related quality of life.
Methods & results: This is a single centre randomised, controlled trial. The two primary end points were graft patency defined as (Thrombolysis In Myocardial Infarction) TIMI III flow in distal anastomosis at angiography 12–24 months after surgery, and cardiac-related health status assesses by Seattle angina questionnaire (SAQ). Original sample size was 300 patients. The trial was stopped prematurely due to unacceptable rate of graft failure (40%) in the composite arm at the 18 months interim analysis.At that point 89 patients were randomised to conventional (46) or composite (43). Baseline characteristics were similar between the two groups apart from diabetes (comp 35% vs 11% in conv p<0.01). Final Analysis was performed on intention to treat basis. Sixty five (73%) had follow up angiography (34 conv , 31 comp, with total of 116 graft in conventional arm and 100 grafts in composite arm. All patients in both groups had LIMA graft to left anterior descending artery (LAD). Graft patency rate was significantly higher in the conventional compared to composite arm [95(82%) vs 59(59%) p<0.001 respectively]. s. There were no significant differences between the two groups in the percentage of improvement in the four domains of SAQ(Physical limitation, Angina stability, Angina frequency, Quality of life).
Conclusions: In our randomised trial, composite bypass graft surgery was associated with higher graft failure rate at 12–24 months after surgery compared to conventional type. This difference may be due to the composite conduit configuration. Despite the difference in graft patency there were no differences in physical limitation, angina stability, angina frequency, or quality of life between the two groups.
- © 2010 by American Heart Association, Inc.