Abstract 12173: Short- and Long-term Outcomes of Total-arterial Revascularization in Multi-vessel Coronary Artery Disease With T-grafting of Bilateral Internal Thoracic Artery
Objectives: ‘Total-arterial' and ‘complete' revascularization are cardiac surgical principles that have been proven to beneficially impact outcomes in coronary artery bypass graft (CABG) surgery. The use of bilateral internal thoracic artery (BITA) with T-grafting is an approach that can achieve both.
Methods: Between January 2004 and March 2012, a total of 408 patients underwent first-time, isolated CABG surgery using BITA with T-grafting. Patients were analyzed for mortality and major adverse cardiac and cerebrovascular events (MACCE). Prospectively recorded clinical data were screened for all-cause death, MACCE, and repeat angina & revascularization at 30 days and at follow-up. Logistic regression models were constructed to identify predictors for short- and long-term survival.
Results: Patients (age, 63±10 years [mean±SD], 21% female) presented triple-vessel coronary artery disease in 95% and risk factors for BITA use, such as obesity, diabetes, or COPD were present in 36%, 23% and 11% of the patients. BITA was used for T-grafting in all patients. Mean bypass time and ischemic time was 105±28 min and 77±19 min with 4.0±0.9 distal coronary anastomoses constructed per patient. Mean transit time graft flow measured at the T-graft was 115±51mL/min. Thoracic re-exploration rate was 2.5% and sternal wound dehiscence's occurred in 3.7% of the patients within the entire follow-up period. All-cause mortality was 1.0% (cardiac-related death 0.7%) and MACCE rate 4.7% at 30 days. Kaplan-Meier survival estimates were 97.4% at 1 year, 96.5% at 5 years, and 95.2 at 8 years of follow-up with a mean follow-up time of 4.7±2.2 years and a completeness of follow-up of 95.6%. Multivariate logistic regression analyses identified body weight (P=0.02) as an independent risk factor for death and COPD (P=0.02) as an independent risk factor for MACCE, whereas LV-function (P<0.001), obesity (P=0.04), and COPD (P=0.02) were identified as risk factors for long-term survival.
Conclusion: Complete and total-arterial revascularization in multi-vessel coronary artery disease can be achieved by the use of BITA and T-grafting with satisfying short-term and excellent long-term outcomes.
- © 2012 by American Heart Association, Inc.