Original article
Adult cardiac
Impact of Total Arterial Reconstruction on Long-Term Mortality and Morbidity: Off-Pump Total Arterial Reconstruction Versus Non-Total Arterial Reconstruction

https://doi.org/10.1016/j.athoracsur.2015.05.034Get rights and content

Background

We were interested in how favorable an influence total arterial reconstruction has on the clinical outcome of patients undergoing off-pump coronary artery bypass graft surgery.

Methods

From January 2002 to December 2013, a total of 1,064 patients underwent isolated off-pump coronary artery bypass graft surgery at our institution. Of these 1,064 patients, 763 underwent total arterial revascularization (AR) and 301 underwent a combination of artery and vein revascularization (AVR). We compared the clinical results between the two groups using the propensity score matching technique.

Results

In all, 260 cases from the AVR group and 520 from the AR group were successfully matched. All procedures were performed using the off-pump technique without conversion to on-pump. Eight patients in the AVR group (3.1%) and 5 in the AR group (1.0%) died in hospital. Multivariate analysis revealed that chronic kidney disease (odds ratio 6.9, p < 0.001), urgency (odds ratio 7.3, p < 0.001), and body mass index (odds ratio 1.3, p = 0.02) were independent risk factors for hospital death. Follow-up was complete for 97.6% of the patients to a maximum of 13 years. According to the Kaplan-Meier method, the rate of 12-year freedom from all causes of death was 69.7% for the AVR group and 72.6% for the AR group (p = 0.002), and the corresponding rates for major adverse cardiac events were 83.9% and 87.7% (p = 0.009). By multivariate Cox regression analysis, total arterial reconstruction was identified as a preventive factor for late cardiac events.

Conclusions

Total arterial revascularization has some degree of favorable effect on the long-term clinical outcome of patients undergoing off-pump coronary artery bypass graft surgery.

Section snippets

Patients and Methods

The Institutional Review Board approved the study. All patients had previously granted permission for use of their medical records for research purposes. Between January 2002 and December 2013, 1,064 consecutive patients underwent isolated off-pump CABG at Shiga Medical University Hospital. Of these 1,064 patients, 763 underwent total arterial revascularization (AR group) and 301 underwent a combination of artery and vein grafting (AVR group). The propensity score, which was the probability

Results

By matching propensity score, 520 AR and 260 AVR patients were successfully matched in a one-to-two manner. The C-statistic was 0.66 (p < 0.001), and the Hosmer-Lemeshow goodness-of-fit test result was not statistically significant (p = 0.89), indicating, respectively, good discriminative power and acceptable calibration of the model. The preoperative characteristics of the patients are summarized in Table 1. The mean patient age was older in the AVR group (70.8 years) than in the AR group

Comment

The present study has several major advanced features that make it quite different from previous studies. At our institute, all procedures were performed using the off-pump technique without exclusion criteria by two high-volume surgeons who were familiar with the technique. From the beginning of the study, off-pump CABG was applied to all CABG procedures even in cases of emergency, acute myocardial infarction, or hemodynamic instability. Our favorite arterial conduits are the BITAs and the

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    Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.