Ho Young Hwang1, Hong Chul Oh1, Yong Han Kim1, Ki-Bong Kim2. 1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea. 2. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: kimkb@snu.ac.kr.
Abstract
BACKGROUND: We evaluated whether revascularization using a Y-composite graft based on the left internal thoracic artery (ITA) is sufficient for patients with 3-vessel disease. METHODS: Of 542 patients who underwent complete revascularization for 3-vessel disease, patients who received either single inflow from a left ITA-based Y-composite graft (group S, n = 297) or who received multiple inflows (including bilateral in situ ITAs, in situ right gastroepiploic artery, or aortocoronary grafts) (group M, n = 245) were compared. Clinical outcomes and myocardial perfusion improvement during the first postoperative year were studied. Baseline differences between groups were adjusted by inverse probability of treatment weighting (IPTW). Median follow-up duration was 94 (2 to 176) months. RESULTS: There were no differences in early mortality (4 of 297 vs 4 of 245; p > 0.999) and morbidity rates between the 2 groups, except atrial fibrillation (which was higher in group S than in group M; p < 0.001). There were no differences between the 2 groups in IPTW-adjusted overall survival, freedom from cardiac death, and freedom from major adverse cardiac and cerebrovascular events at 5 and 10 years (group S, 85.2% and 76.2% vs group M, 88.6% and 74.1%, p = 0.990). The IPTW-adjusted Cox proportional hazard model demonstrated that age (p = 0.030) and aortocoronary saphenous vein grafting (p = 0.002) were risk factors for major adverse cardiac and cerebrovascular events. Myocardial single photon emission computed tomography performed preoperatively, and 3 months and 1 year postoperatively demonstrated similar patterns of myocardial perfusion improvement between the 2 groups (p = 0.483). CONCLUSIONS: Revascularization using a Y-composite graft based on the left ITA for single inflow was sufficient for patients with 3-vessel disease in terms of early and long-term clinical outcomes and myocardial perfusion improvement.
BACKGROUND: We evaluated whether revascularization using a Y-composite graft based on the left internal thoracic artery (ITA) is sufficient for patients with 3-vessel disease. METHODS: Of 542 patients who underwent complete revascularization for 3-vessel disease, patients who received either single inflow from a left ITA-based Y-composite graft (group S, n = 297) or who received multiple inflows (including bilateral in situ ITAs, in situ right gastroepiploic artery, or aortocoronary grafts) (group M, n = 245) were compared. Clinical outcomes and myocardial perfusion improvement during the first postoperative year were studied. Baseline differences between groups were adjusted by inverse probability of treatment weighting (IPTW). Median follow-up duration was 94 (2 to 176) months. RESULTS: There were no differences in early mortality (4 of 297 vs 4 of 245; p > 0.999) and morbidity rates between the 2 groups, except atrial fibrillation (which was higher in group S than in group M; p < 0.001). There were no differences between the 2 groups in IPTW-adjusted overall survival, freedom from cardiac death, and freedom from major adverse cardiac and cerebrovascular events at 5 and 10 years (group S, 85.2% and 76.2% vs group M, 88.6% and 74.1%, p = 0.990). The IPTW-adjusted Cox proportional hazard model demonstrated that age (p = 0.030) and aortocoronary saphenous vein grafting (p = 0.002) were risk factors for major adverse cardiac and cerebrovascular events. Myocardial single photon emission computed tomography performed preoperatively, and 3 months and 1 year postoperatively demonstrated similar patterns of myocardial perfusion improvement between the 2 groups (p = 0.483). CONCLUSIONS: Revascularization using a Y-composite graft based on the left ITA for single inflow was sufficient for patients with 3-vessel disease in terms of early and long-term clinical outcomes and myocardial perfusion improvement.