Best Conduits and Best Surgeons for the Best Outcome

Myocardial revascularization surgery is still one of the most effective treatment strategies against coronary disease. One of the most important advantages of surgery over angioplasty is the chance to reach complete revascularization. This has proven to improve the survival of patients and to reduce the number of cardiovascular events.

Tasa de stroke post cirugía vs angioplastia coronaria en un análisis de más de 10.000 pacientes

The choice of conduit for the grafts is critical to ensure their patency (ultimately, to ensure complete revascularization for a longer time).

Given the accelerated decay of vein grafts (50% are occluded at 10 years), the internal thoracic artery has become the gold standard to connect the anterior descending artery.

However, the use of arterial grafts from an artery other than the internal thoracic artery is very low. The bilateral internal thoracic artery is used in around 4.9% of cases, and the radial artery is used in 6.5% of cases.


Read also: Do Polymers Play any Role in Drug Eluting Stents.


The lack of adoption of full arterial revascularization is partially due to a lack of solid, unequivocal evidence on its benefit.

While several series and meta-analysis have shown the benefit of arterial revascularization, recent randomized studies have not been able to do so. This means that there is no solid evidence justifying its higher technical difficulty, its higher procedural time, and its potential complications.

This study, published in J Am Coll Cardiol, included an impressive group of 61,310 patients who underwent coronary artery bypass graft surgery with a single arterial graft (n = 49,076; 80%) or multiple arterial grafts (n = 12,234; 20%). Authors used propensity score matching to reduce the differences between groups. At 1 year, there were no differences between strategies, but at 7 years, the rates of mortality, infarction, and new revascularization were significantly lower in the multiple arterial grafts group.

The greatest strength of this study is the huge number of patients enrolled in 42 hospitals and with 246 surgeons, which can paint a realistic picture of daily clinical practice.



Read also: TAVR in Bicuspid Has the Same Results in Surgery at Hospital Level.


The lowest mortality rates in the multiple arterial grafts group were found in the most experienced sites as regards this strategy.

Another important piece of information is that arterial grafts were significantly associated with wound infections.

Conclusion

The rates of mortality and combined events at 1 year were similar between surgery with a single arterial graft and multiple arterial grafts. However, at 7 years, multiple arterial grafts showed clear benefit from all points of view.

Original title: Multiple Versus Single Arterial Coronary Bypass Graft Surgery for Multivessel Disease.

Reference: Zaza Samadashvili et al. J Am Coll Cardiol 2019;74:1275–85.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....