Department of Cardiovascular Medicine and Surgery, Cliniques Universitaire St Luc, Université Catholique de Louvain, Brussels, Belgium.
Eur J Cardiothorac Surg. 2012 Aug;42(2):284-90; discussion 290-1. doi: 10.1093/ejcts/ezr302. Epub 2012 Jan 26.
The long-term advantages of multiple arterial grafts, particularly a third arterial conduit, for coronary artery bypass (CABG) are not clear. This study was designed to test whether multiple arterial grafts would provide better long-term outcomes when compared with approaches using fewer arterial conduits.
Between 1985 and 1995, prospective data were collected for 588 patients undergoing isolated CABG at our institution. We examined long-term survival and freedom from cardiac death. The primary analysis compared patients receiving bilateral internal thoracic artery (BITA) vs. single ITA (SITA). In a subgroup analysis, BITA patients receiving a right gastroepiploic artery (RGEA) were compared with those receiving a saphenous vein graft (SVG) as a third conduit. Cox proportional hazard modelling was used to adjust for relevant confounders. The Kaplan-Meier method was used to create survival curves over the follow-up period.
The mean age was 59 ± 9 years and 49% received BITA. Mean follow-up was 16.1 ± 5.4 years. Multivariable analysis revealed that overall survival [hazard ratio (HR): 0.74, P = 0.017] and cardiac survival (HR: 0.61, P = 0.004) was significantly improved in the presence of BITA compared with SITA. The survival at 10 and 20 years was 90.2 ± 3.4 and 56.9 ± 6.4% for the BITA vs. 82 ± 4.4 and 40.9 ± 6% for the SITA, respectively. In the subgroup of BITA patients, those receiving the RGEA as a third conduit had superior overall survival (HR: 0.41, P = 0.0032) and cardiac survival (HR: 0.18, P = 0.004) compared with those receiving an SVG. The survival at 10 and 20 years was 98.9 ± 2 and 68.9 ± 18% for the BITA/RGEA vs. 87.2 ± 4.6 and 50.3 ± 7% for the BITA/SVG, respectively.
In a single-institution experience, the use of multiple arterial grafting is independently associated with superior outcomes. Furthermore, the use of a third arterial conduit (RGEA) targeted to the right coronary artery should be considered to improve long-term survival.
多支动脉移植物（特别是第三支动脉移植物）在冠状动脉旁路移植术（CABG）中的长期优势尚不清楚。本研究旨在检验与使用较少动脉移植物的方法相比，多支动脉移植物是否能提供更好的长期结果。
1985 年至 1995 年期间，我们对在我院接受单纯 CABG 的 588 例患者进行了前瞻性数据收集。我们检查了长期生存和无心脏死亡情况。主要分析比较了接受双侧内乳动脉（BITA）与单侧内乳动脉（SITA）的患者。在亚组分析中，接受右胃网膜动脉（RGEA）作为第三根移植物的 BITA 患者与接受大隐静脉移植物（SVG）的患者进行比较。Cox 比例风险模型用于调整相关混杂因素。Kaplan-Meier 方法用于创建随访期间的生存曲线。
平均年龄为 59 ± 9 岁，49%的患者接受了 BITA。平均随访时间为 16.1 ± 5.4 年。多变量分析显示，与 SITA 相比，BITA 组的总体生存率[风险比（HR）：0.74，P = 0.017]和心脏生存率（HR：0.61，P = 0.004）显著提高。BITA 组的 10 年和 20 年生存率分别为 90.2 ± 3.4%和 56.9 ± 6.4%，SITA 组分别为 82 ± 4.4%和 40.9 ± 6%。在 BITA 患者亚组中，接受 RGEA 作为第三根移植物的患者具有更好的总体生存率（HR：0.41，P = 0.0032）和心脏生存率（HR：0.18，P = 0.004）。10 年和 20 年的生存率分别为 BITA/RGEA 组的 98.9 ± 2%和 68.9 ± 18%，以及 BITA/SVG 组的 87.2 ± 4.6%和 50.3 ± 7%。
在单机构经验中，使用多支动脉移植物与更好的结果独立相关。此外，应考虑使用第三支动脉移植物（RGEA）靶向右冠状动脉，以提高长期生存率。
