OPCAB, arterial grafting to circumflex area ‘reasonable’ in isolated CABG
MedWire News: Off-pump surgery and arterial grafting to the circumflex area are “reasonable” approaches in isolated coronary artery bypass graft (CABG) surgery, researchers in Japan concluded from their study of over 3000 patients receiving a range of graft types.
The team found that off-pump CABG (OPCAB) was not associated with the risk for graft failure, while patency of arterial grafts overall was better than that achieved with saphenous vein grafts (SVGs) in the circumflex area.
To improve knowledge of the performance of different graft types and method of revascularization in patients undergoing CABG, Junjiro Kobayashi (National Cardiovascular Center, Osaka) and team examined results of routine early postoperative angiography in 3532 patients, aged 66 years on average, of whom 85% had undergone OPCAB.
The average number of distal anastomoses was 3.4, of grafts 2.4, and of arterial graft anastomoses 2.9, and 36% of grafts were left internal thoracic artery (LITA), 18% right ITA (RITA), 10% gastroepiploic artery (GEA), 19% radial artery (RA), and 17% SVG with regard to the distal anastomosis.
The overall bypass occlusion rate was 3.1% and OPCAB was not a risk factor for graft occlusion, reported the researchers at the European Association of Cardio-thoracic Surgery annual meeting in Vienna, Austria.
In OPCAB patients, the occlusion rate with SVG was significantly higher than for LITA, RITA, RA, and GEA, while the rates for RA and GEA were significantly higher than for LITA and RITA (p<0.001 for both comparisons). Occlusion rates did not differ significantly among graft materials in standard CABG patients, however.
Further analysis showed that the graft occlusion and stenosis rate for RITA grafted to the left anterior descending artery (LAD) was significantly higher than that of LITA to LAD (6.1% vs 3.8%, p=0.013) but the difference in occlusion rate alone (2.4% vs 1.4%) did not reach significance.
In the circumflex area, the occlusion rate was significantly higher for SVG (7.1%) than that for all the arterial grafts, at 4.2% for LITA (p=0.03), 1.7% for RITA (p<0.001), 2.2% for RA (p<0.001), and 3.7% for GEA (p=0.029).
In contrast, bypass occlusion rate in the right coronary territory was not related to graft material. But bypass occlusion and stenosis of both RITA and GEA to the right main coronary artery (11.1% and 13.3%, respectively) were significantly more frequent than that of RA (0.0%) and SVG (2.0%) in this area (p<0.02 for all comparisons).
LITA proved the optimal graft for LAD, and RA was as good as RITA and better than SVG in the circumflex area, while RITA and GEA should be avoided as a graft to the right main coronary artery, Kobayashi and team summarized.
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By Caroline Price