The effect on survival from the use of a saphenous vein graft during coronary bypass surgery: a large cohort study†

Royse, Alistair; Pawanis, Zulfayandi; Canty, David; Ou-Young, Jared; Eccleston, D.; Ajani, A.; Reid, Christopher M.; Bellomo, Rinaldo; Royse, Colin

doi:10.1093/ejcts/ezy213

Cited by 37 publications

(33 citation statements)

References 25 publications

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“…Reproduced with permission, JACC 2018 [37] . LIMA-RA-Y: left internal mammary artery radial artery Y graft; TAR: total arterial revascularisation survival outcomes compared to SVG [37,40,[42][43][44] . Therefore, the study design of one versus two IMA, rather than one versus two arterial grafts was confounded by RA being used.…”

Section: Is Multi-arterial Grafting Significantly Better Than Single mentioning

confidence: 99%

“…"The chicken and the egg" dilemma The obvious consequence of increasing use of arterial grafts is that there is a compensatory reduction in the number of SVG being used. We conducted an analysis whereby the number of grafts was restricted and then performed separate matching for all grafting combinations within each stratum [42] [ Figure 5]. For each stratum, the increasing use of SVG (and reduction in the use of arterial grafts) resulted in an increasing mortality hazard.…”

Section: Is Multi-arterial Grafting Significantly Better Than Single mentioning

confidence: 99%

“…Survival with one or more SVG was lower than for TAR [ Figure 6]. The survival advantage of TAR remained even when there was a majority of grafts that were arterial (multiarterial) and with one SVG [42] [ Figure 7].…”

Section: Count the Veins Not The Arteriesmentioning

confidence: 99%

“…There is no evidence that the forearm has reduced blood flow following RA harvest [62] . Reproduced with permission EJCTS 2018 [42] . SVG: saphenous vein graft; Art: arterial grafts; 0 SVG or SVG = 0, total arterial revascularisation Figure 6.…”

Section: Potential Risks Of Multi-arterial Graftingmentioning

confidence: 99%

“…Propensity score matched comparison of total arterial revascularisation and the use of one or more saphenous vein grafts, n = 12,316 pairs. Reproduced with permission EJCTS 2018 [42] . SVG = 0, total arterial revascularisation; SVG = 1, use of one single saphenous vein graft irrespective of the number of arterial grafts (number of arterial grafts 1.7 ± 1.1); KM: Kaplan-Meier; Cox: Cox proportional hazards method; HR: hazard ratio; 95%CI: 95% confidence interval; SVG: saphenous vein graft…”

Section: Potential Risks Of Multi-arterial Graftingmentioning

confidence: 99%

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Why and how to achieve total arterial revascularisation in coronary surgery

Royse¹,

Royse²,

Boggett³

et al. 2020

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Single internal mammary artery and supplementary saphenous vein grafts (SVG) continues to be used in approximately 95% of coronary surgery as of 2019. The late failure of SVG is very well documented yet remains the predominant conduit used-why? The left internal mammary artery almost never fails, and late angiography of patent radial artery grafts also appear entirely normal. Logic would suggest that avoiding the conduit known to progressively fail would lead to improved late outcome. Our studies have demonstrated such findings in large single centre and national registry datasets. We describe strategies to achievement of total arterial coronary revascularisation.

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Section: Is Multi-arterial Grafting Significantly Better Than Single mentioning

confidence: 99%

Section: Is Multi-arterial Grafting Significantly Better Than Single mentioning

confidence: 99%

Section: Count the Veins Not The Arteriesmentioning

confidence: 99%

Section: Potential Risks Of Multi-arterial Graftingmentioning

confidence: 99%

Section: Potential Risks Of Multi-arterial Graftingmentioning

confidence: 99%

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Why and how to achieve total arterial revascularisation in coronary surgery

Royse¹,

Royse²,

Boggett³

et al. 2020

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Long-term Outcomes Associated With Total Arterial Revascularization vs Non–Total Arterial Revascularization

et al. 2020

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IMPORTANCEThe optimal conduits for coronary artery bypass grafting (CABG) remain controversial in multivessel coronary artery disease.OBJECTIVE To compare the long-term clinical outcomes of total arterial revascularization (TAR) vs non-TAR (CABG with at least 1 arterial and 1 saphenous vein graft) in a multicenter population-based study. DESIGN, SETTING, AND PARTICIPANTSThis multicenter population-based cohort study using propensity score matching took place from October 2008 to March 2017 in Ontario, Canada, with a mean and maximum follow-up of 4.6 and 9.0 years, respectively. Individuals with primary isolated CABG were identified, with at least 1 arterial graft. Exclusion criteria were individuals from out of province and younger than 18 years. Patients undergoing a cardiac reoperation or those in cardiogenic shock were also excluded because these conditions would potentially bias the surgeon toward not performing TAR. Analysis began April 2019. EXPOSURES Total arterial revascularization.MAIN OUTCOMES AND MEASURES Primary outcome was time to first event of a composite of death, myocardial infarction, stroke, or repeated revascularization (major adverse cardiac and cerebrovascular events). Secondary outcomes included the individual components of the primary outcome. RESULTSOf 49 404 individuals with primary isolated CABG, 2433 (4.9%) received TAR, with the total number of bypasses being 2, 3, and 4 or more vessels in 1521 (62.5%), 865 (35.6%), and 47 individuals (1.9%), respectively. The mean (SD) age was 61.2 (10.4) years and 1983 (81.5%) were men. After propensity score matching, 2132 patient pairs were formed, with equal total number of bypasses (mean [SD], 2.4 [0.5]) but with more arterial grafts in the TAR group (mean [SD], 2.4 [0.5] vs 1.2 [0.4]; P < .01). In-hospital death (15 [0.7%] vs 21 [1.0%]; P = .32) did not differ between TAR vs non-TAR groups after propensity score matching. Throughout 8 years, TAR was associated with improved freedom from major adverse cardiac and cerebrovascular events (hazard ratio, 0.78; 95% CI, 0.68-0.89), death (hazard ratio, 0.80; 95% CI, 0.66-0.97), and myocardial infarction (hazard ratio, 0.69; 95% CI, 0.51-0.92). There was no difference in stroke and repeated revascularization.CONCLUSIONS AND RELEVANCE Total arterial revascularization was associated with improved long-term freedom from major adverse cardiac and cerebrovascular events, death, and myocardial infarction and may be the procedure of choice for patients with reasonable life expectancy requiring CABG.

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Impact of target vessel choice on outcomes following percutaneous coronary intervention in patients with a prior coronary artery bypass graft

Beerkens

Singh

Cao

et al. 2021

Cathet Cardio Intervent

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Objectives: To evaluate and compare characteristics and clinical outcomes of percutaneous coronary intervention (PCI) among target vessel types in patients with a prior coronary artery bypass graft (CABG) surgery.Background: Patients with a prior CABG often require repeat revascularization with PCI. Graft PCI has been associated with worse outcomes compared to native vessel PCI, yet the optimal PCI strategy in prior CABG patients remains unknown.Methods: We stratified prior CABG patients who underwent PCI at a tertiary-care center between 2009 and 2017 by target vessel type: native vessel, venous graft, and arterial graft. The primary outcome of major adverse cardiac events (MACE) was a composite of all-cause death, myocardial infarction, stent thrombosis, or target vessel revascularization up to 1 year post-PCI.Results: Prior CABG patients (n = 3983) represented 19.5% of all PCI interventions during the study period. PCI was most frequently performed on native vessels (n = 2928, 73.5%) followed by venous (n = 883, 22.2%) and arterial grafts (n = 172, 4.3%). Procedural success and complications were similar among the groups; however, slow-and no-reflow phenomenon was more common in venous graft PCI compared to

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The effect on survival from the use of a saphenous vein graft during coronary bypass surgery: a large cohort study†

Abstract: Any use of SVGs is independently associated with reduced survival after coronary artery bypass surgery.

Cited by 37 publications

References 25 publications

Why and how to achieve total arterial revascularisation in coronary surgery

Why and how to achieve total arterial revascularisation in coronary surgery

Long-term Outcomes Associated With Total Arterial Revascularization vs Non–Total Arterial Revascularization

Impact of target vessel choice on outcomes following percutaneous coronary intervention in patients with a prior coronary artery bypass graft

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