Coronary Artery Bypass Surgery Without Saphenous Vein Grafting

Royse, Alistair; Ren, Justin; Royse, Colin; Tian, David H.; Fremes, Stephen E.; Gaudino, Mario; Benedetto, Umberto; Woo, Y. Joseph; Goldstone, Andrew B.; Davierwala, Piroze; Borger, Michael A.; Vallely, Michael P.; Reid, C.; Rocha, Rodolfo V.; Glineur, David; Grau, Juan B.; Shaw, Richard E.; Paterson, Hugh S.; El-Ansary, Doa; Boggett, Stuart; Srivastav, Nilesh; Pawanis, Zulfayandi; Canty, David; Bellomo, Rinaldo

doi:10.1016/j.jacc.2022.08.795

Cited by 11 publications

(9 citation statements)

References 51 publications

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“…We found that the complete avoidance of SVG or TAR reduced long-term all-cause mortality (HR, 0.78; 95% CI, 0.72–0.85; p = 0.010) after propensity score and Cox-regression adjustments ( Figure 1 ). This was confirmed by a Bayesian analysis suggesting a > 99.9% posterior probability that SVG was the cause of the lower observed late survival in the non-TAR group and a 99.8% probability for an effect size of HR < 0.9 [ 23 ]. Kaplan–Meier survival analysis on the digitized individual patient data indicated an early and incremental separation between TAR and non-TAR over time ( Figure 2 ) (log rank p < 0.001).…”

Section: Total Arterial Revascularizationmentioning

confidence: 77%

“… Total arterial revascularization vs. non-total arterial revascularization: combined literature review and expanded multicenter collaborative data set meta-analysis. Reproduced with permission [ 23 ] Royse A, et al, J Am Coll Cardiol. 2022; 80(19):1833–1843.…”

Section: Figurementioning

confidence: 99%

“… Survival advantage for total arterial revascularization in coronary bypass grafting. Reproduced with permission [ 23 ] Royse A, et al, J Am Coll Cardiol. 2022; 80(19): 1833–1843.…”

Section: Figurementioning

confidence: 99%

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Late Clinical Outcomes of Total Arterial Revascularization or Multiple Arterial Grafting Compared to Conventional Single Arterial with Saphenous Vein Grafting for Coronary Surgery

Ren

Royse

2023

JCM

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Coronary surgery provides better long-term outcomes than percutaneous coronary intervention. Conventional practice is to use a single arterial conduit supplemented by saphenous vein grafts. The use of multiple arterial revascularization (MAG), or exclusive arterial revascularization (TAR), however, is reported as having improved late survival. Survival is a surrogate for graft failure that may lead to premature death, and improved survival reflects fewer graft failures in the non-conventional strategy groups. The reasons for not using MAG or TAR may be due to perceived technical difficulties, a lack of definitive large-scale randomized evidence, a lack of confidence in arterial conduits, or resources or time constraints. Most people consider radial artery (RA) grafting to be new, with use representing approximately 2–5% worldwide, despite select centers reporting routine use in most patients for decades with improved results. In conclusion, the current body of evidence supports more extensive use of total and multiple arterial revascularization procedures in the absence of contraindications.

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Section: Total Arterial Revascularizationmentioning

confidence: 77%

Section: Figurementioning

confidence: 99%

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Late Clinical Outcomes of Total Arterial Revascularization or Multiple Arterial Grafting Compared to Conventional Single Arterial with Saphenous Vein Grafting for Coronary Surgery

Ren

Royse

2023

JCM

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“…4 Growing evidence supports the use of total arterial grafting in coronary surgery as there seems to be improved overall survival. 5 Most of the RA-MIDCAB or totally endoscopic CAB (TECAB) procedures were performed for single-vessel disease. However, experienced teams demonstrated the feasibility of performing multiple arterial bypass using both ITAs, with an average of 2.4 anastomoses per patient in multivessel disease.…”

Section: Introductionmentioning

confidence: 99%

Robot-Assisted MIDCAB Using Bilateral Internal Thoracic Artery: A Propensity Score–Matched Study With OPCAB Patients

Algoet,

Verbelen,

Jacobs

et al. 2024

Innovations�(Phila)

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Objective: Robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) is an attractive strategy for coronary revascularization. Growing evidence supports the use of total arterial grafting in coronary surgery. We evaluated total arterial left-sided coronary revascularization with bilateral internal thoracic artery (BITA) using RA-MIDCAB and compared it with a propensity score–matched (PSM) off-pump CAB (OPCAB) surgery population. Methods: We retrospectively included all isolated OPCAB and RA-MIDCAB surgery using BITA without saphenous vein graft from January 1, 2015, to October 31, 2022. We analyzed all our RA-MIDCAB patients and performed PSM to compare them with our OPCAB population. Primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE) and mortality. Secondary outcomes were surgical parameters, length of hospital stay, and learning curve. Results: We included 601 OPCAB and 77 RA-MIDCAB procedures, which resulted in 2 cohorts of 54 patients after PSM. Mortality and MACCE survival analysis showed no significant difference. There was less blood transfusion in the RA-MIDCAB (16.7%) compared with the OPCAB group (38.9%; P = 0.02). We observed fewer intensive care unit (ICU) admissions (24.1% vs 96.6%), shorter ICU stay (0.78 ± 1.7 vs 1.91 ± 1.01 days), and shorter hospital stay (6.78 ± 2.4 vs 8.01 ± 2.5 days) in the RA-MIDCAB versus OPCAB group ( P < 0.01). Surgery time decreased from 400.0 ± 70.8 to 325.0 ± 38.0 min with more experience in RA-MIDCAB BITA harvesting ( P < 0.01). Conclusions: This is a first publication of 77 consecutive RA-MIDCAB BITA harvesting for left coronary artery system revascularization. This technique is safe in terms of MACCE and mortality. Additional advantages are shorter length of hospital stay, fewer ICU admissions, and less blood transfusion.

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“…This helps avoid an extra conduit (usually a vein) and an additional wound. 8 The possible disadvantages of this technique may be an increase in crossclamp time by 5 to 10 minutes per baby Y graft and an initial learning curve. In our observation, this can be buried against the greater goal of achieving complete revascularization.…”

mentioning

confidence: 99%

Baby Y anastomosis, the journey towards total arterial complete myocardial revascularization

Ratnaraj¹,

Tripathy²,

Ivanov³

et al. 2023

JTCVS Techniques

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Coronary Artery Bypass Surgery Without Saphenous Vein Grafting

Cited by 11 publications

References 51 publications

Late Clinical Outcomes of Total Arterial Revascularization or Multiple Arterial Grafting Compared to Conventional Single Arterial with Saphenous Vein Grafting for Coronary Surgery

Late Clinical Outcomes of Total Arterial Revascularization or Multiple Arterial Grafting Compared to Conventional Single Arterial with Saphenous Vein Grafting for Coronary Surgery

Robot-Assisted MIDCAB Using Bilateral Internal Thoracic Artery: A Propensity Score–Matched Study With OPCAB Patients

Baby Y anastomosis, the journey towards total arterial complete myocardial revascularization

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