Journal of Surgery

Research Article

Twenty-Year Follow-up: Multiple Arterial Grafting Is Associated with Better Outcomes for Coronary Artery Bypass Grafting Patients

Chanapong Kittayarak MD*, Panat Kittisit MD, Chalit Cheanvechai MD, Pimchanok Junnil MD, Vichai Benjacholamas MD, Seri Singhatanadgige MD, Pat Ongcharit MD and Jule Namchaisiri MD

Cardiovascular and Thoracic Surgery Unit, Department of Surgery, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
*Address for Correspondence: Kittayarak C, Cardiovascular and Thoracic Surgery Unit, Department of Surgery, King Chulalongkorn Memorial Hospital, Bangkok, Thailand Email: chanapongk@hotmail.com
Submission: 07 August, 2022 Accepted: 02 September, 2022 Published: 05 September, 2022
Copyright: © 2022 Kittayarak C, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives: The optimal conduits for coronary artery bypass grafting (CABG) remain controversial in multivessel coronary artery disease. Some studies have shown that multiple arterial conduits offer better long-term survival. We sought to analyze the long term outcomes of arterial graft during CABG in our institute.
Methods: Retrospective cohort analyses of all patients undergoing primary isolated CABG in King Chulalongkorn Memorial Hospital, Bangkok, Thailand, from January 1997 – December 2001. We stratified patients into three groups including patients with multiple arterial graft (MAG) versus single arterial graft (SAG) versus non-arterial graft (NAG). The primary outcome was survival rate. The secondary outcome was time to first event of a composite of death, MI, stroke, and repeat revascularization (major adverse cardiac and cerebrovascular events, MACCE).
Results: Four hundred sixty four patients underwent isolated CABG during our study period; 67 patients (14.4%) in multiple arterial graft group (MAG), 293 patients (63.1%) in single arterial graft group (SAG) and 104 patients (22.5%) in non-arterial graft group (NAG). Mean and maximum follow-up was 12.5 and 24.5 years, respectively. Median age of population is 63 years (IQR 56-69) with 60 years in MAG, 63 years in SAG and 66 years in NAG (P < 0.001).Most common second arterial conduit is radial artery grafting, accounting for 76 patients (16.4%). Other baseline characteristics are not different between groups. In-hospital mortality was 0% for MAG vs 1.7% in SAG and 5.8% in NAG (P = 0.04). On the other hand, 20-year survival of MAG, SAG and NAG is 52.9%, 44.3% and 23.7%, respectively. At 20 years, incidences of MACCE, survival, repeat revascularization, and myocardial infarction were inferior in multiple arterial groups. The risk factors associated with death were non-arterial graft, age more than 60 years, low BMI, diabetic mellitus, renal dysfunction, pre-operative IABP, cardiopulmonary bypass time more than 75 minutes and postoperative atrial fibrillation.
Conclusion: CABG with multiple arterial grafts was associated with better clinical outcomes compare with single and non-arterial graft at 20-year follow-up.