Total arterial revascularization with composite T-grafts: Is outcome related to surgical experience?

Objective: Total arterial revascularisation (TAR) can be achieved with only two grafts when composite T-grafting is performed. However, the single inflow into the composite graft may be a risk factor for graft failure and myocardial ischemia. A high surgical quality of the LITA preparation, T-grafting and conduit length estimation is essential. The surgeon's operative experience may be a risk factor for postoperative outcome.

Methods: We reviewed the data of 1139 consecutive patients (89% male, age: 62±9y) who underwent T-grafting for multi-vessel CAD between 1996 and 2010 in our institution. We compared the early postoperative outcome of patients operated on by experienced TAR surgeons (group A) and surgeons in their early career (group B). Endpoints were 30d-mortality, incidence of myocardial infarction (MI) and low cardiac output. Additionally, logistic regression analysis was performed to reveal independent risk factors for adverse outcome.

Results: Group A patients had a higher Euroscore (group A 4.5% vs. Group B 3.8%; p<0.05). Postoperative data did not show significant differences in complications such as MI (group A 2.3% vs. group B 3.1%, P=0.53) and low cardiac output (group A 1.3% vs. group B 2.3%, P=0.54). 30day-mortality was comparably low in both groups (group A 0.6% vs. group B 0.8%, P=1.0).

Conclusions: Total arterial revascularization with composite T-grafts can be achieved with extremely low complication rates irrespective of the surgeon's operative experience. The use of T-grafts can be recommended as a universal technique for the treatment of multivessel coronary artery disease in a wide range of patients.