HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Légaré, J. F. Articles by Hirsch, G. M. Search for Related Content PubMed PubMed Citation Articles by Légaré, J. F. Articles by Hirsch, G. M. Related Collections Coronary disease

J Thorac Cardiovasc Surg 2004;127:160-166
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Composite arterial grafts versus conventional grafting for coronary artery bypass grafting

^a Dalhousie University, Halifax, Nova Scotia, Canada

Received for publication January 21, 2003; revisions received June 14, 2003; accepted for publication June 23, 2003.

^* Address for reprints: Dr Gregory Hirsch, New Halifax Infirmary QEII HSC, 1796 Summer St, Rm 2269, Division of Cardiac Surgery, Halifax, Nova Scotia, Canada B3H 3A7
ghirsch{at}is.dal.ca

OBJECTIVES: Composite arterial grafts for coronary artery bypass grafting surgery allow complete arterial revascularization but are limited by the inflow of a single internal thoracic artery supplying all the grafted vessels. We reviewed the safety of composite arterial grafts using either bilateral internal thoracic arteries or a single internal thoracic artery and radial artery.

METHODS: From January 1999 to July 2002, 402 consecutive patients receiving composite grafts only were compared to a control group of patients (n = 542) undergoing coronary artery bypass grafting with internal thoracic artery and saphenous veins operated upon by the same surgeons. Two different statistical approaches were used to compare groups in this retrospective analysis. First, propensity score analysis with greedy matching technique was used to match patients from each group. Second, a multivariate analysis was performed looking at a combined patient outcome of death, intra-aortic balloon counterpulsation utilization, myocardial infarction, stroke, and prolonged ventilation on all patients in both groups.

RESULTS: After matching by propensity score, the major clinical outcomes in composite arterial (n = 249) and control (n = 249) groups were found to be similar. The in-hospital mortality in the composite group was 1.2% as compared with 0.4% in matched patients (P = .62). However, patients in the composite group were found to have a significantly longer pump time (P < .0001), longer clamp time (P < .0001), increased incidence of prolonged mechanical ventilation (12.8% vs 4.8%; P = .002), and higher incidence of combined morbidity outcome (13.6% vs 6.4%; P = .007) as compared with matched patients. Multivariable analysis showed that composite arterial grafting was an independent predictor of the combined morbidity outcome with an odds ratio of 2.1 (1.2-3.7).

CONCLUSIONS: These findings suggest that composite arterial grafting may be associated with an increase in risk-adjusted patient morbidity when compared with a conventional coronary artery bypass grafting group, although a mortality difference was not demonstrable.

This article has been cited by other articles:

				P. C. Austin Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement. J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1128 - 1135. [Abstract] [Full Text] [PDF]

				R. J.F. Baskett, F. H. Cafferty, S. J. Powell, R. Kinsman, B. E. Keogh, and S. A.M. Nashef Total Arterial Revascularization is Safe: Multicenter Ten-Year Analysis of 71,470 Coronary Procedures Ann. Thorac. Surg., April 1, 2006; 81(4): 1243 - 1248. [Abstract] [Full Text] [PDF]

				H. Nishida, Y. Tomizawa, M. Endo, and H. Kurosawa Survival Benefit of Exclusive Use of In Situ Arterial Conduits Over Combined Use of Arterial and Vein Grafts for Multiple Coronary Artery Bypass Grafting Circulation, August 30, 2005; 112(9_suppl): I-299 - I-303. [Abstract] [Full Text] [PDF]

				J. S. Lawton, H. B. Barner, M. S. Bailey, T. J. Guthrie, N. Moazami, M. K. Pasque, M. R. Moon, and R. J. Damiano Jr Radial Artery Grafts in Women: Utilization and Results Ann. Thorac. Surg., August 1, 2005; 80(2): 559 - 563. [Abstract] [Full Text] [PDF]

				K. Matsuura, J. Kobayashi, O. Tagusari, K. Bando, K. Niwaya, H. Nakajima, T. Yagihara, and S. Kitamura Off-Pump Coronary Artery Bypass Grafting Using Only Arterial Grafts in Elderly Patients Ann. Thorac. Surg., July 1, 2005; 80(1): 144 - 148. [Abstract] [Full Text] [PDF]