MULTIPLE ARTERIAL REVASCULARIZATION IN CABG SURGERY — INVESTIGATION OF LONG-TERM BENEFIT IN A COHORT OF 3129 CONSECUTIVE PATIENTS
Journal Title: Праці Наукового товариства ім. Шевченка - Year 2015, Vol 43, Issue 2
Abstract
Objective: Lacking utilization o f accompanying arterial grafts to a left internal thoracic artery (LITA) in CABG surgery appear to be based on the lack of conviction regarding any long-term benefit. Aim o f our study was to investigate whether multiple arterial revascularization (MAR) has an impact on survival after CABG. Methods: A consecutive series o f 3129 patients undergoingfirst, isolated, non-emergent multivessel CABG procedure from 2001 to 2010 was investigated. MAR was performed in 1068 patients (34.1%) using radial artery in 791 patients (25.3%) and a second ITA graft in 344 patients (11%). The remaining 2061 patients received single ITA and concomitant SVG (conCABG group). Proportional hazard model was performed to estimate independent predictors fo r long-term survival. Results: Median follow up was 56.9 months in the MAR group and 44.5 months in the conCABG group (p<0.001). Baseline characteristics were different regarding age, gender, smoking, cerebro- and peripheral vascular (all <0.001), and pulmonary disease (p=0.04). Actuarial survival at 1, 3, 5, and 8 years was 98.3%, 97.7%, 96.5% and 94.3% in the MAR group compared to 97.1%, 93,1%, 92.1%, and 86.9% in the conCABG group. MAR remained a strong independent predictor fo r long-term survival (Hazard Ratio HR: 0.65; 0.45-0.95; p=0.02). Additionally cerebro-vascular events (HR: 2.1; 1.3-3.5; p=0.003) and peripheral arterial disease (HR: 2.5; 1.9-3.5; p<0.001) revealed significant factors for survival beside age (3.2% increase/year; 1.01-1.05; p<0.001). Multivariate analysis revealed an absolute mortality reduction by MAR o f 2.5% and 4% at 5 and 8 years after CABG. Conclusions: The result o f our study implies that MAR should be the standard-of-care as the survival benefits seem to widen over time.
Authors and Affiliations
Orest CHEVTCHIK, Hanno ULMER, Hannes ALBER, Adel SAKIC, Juliane Kilo, Michael Grimm, Elfriede RUTTMANN
Keywords
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