Does the Choice of Arterial Graft Influence the Outcome in Long-Term Follow-up?

Objective: Aim of the study was to determine factors that influence the long-term outcome in patients undergoing isolated coronary arterial revascularization grafting (CABG) using bilateral internal thoracic arteries (BITA) or left internal thoracic (LITA) and radial arteries (RA).

Methods: From January 2003 to December 2005, a total of 716 patients underwent isolated CABG using BITA (n = 116), BITA + RA (n = 140) or LITA + RA (n = 458) and were investigated retrospectively. Follow-up was done utilizing written questionnaires. Both, patients and their physicians, were interviewed to gather all information possible. Main points were: recurrence of angina, myocardial infarction, cardiac interventions, rhythm disturbances and clinical state according to NYHA-classification.

Results: On average, Patients were 63 ± 9 years old with a logistic EuroSCORE 4.9 ± 6.9%. The hospital mortality was 2.2%. Follow up was completed in 80% of patients with a mean follow-up period of 50 ± 14.6 months. Long-term mortality during follow-up was 8.6% and 184 patients (32.8%) developed a major cardiac event during follow-up. The incidence of mayor cardiac events were influenced by preoperative logistic EuroSCORE (p < 0.001), the length of ICU stay (p < 0.02), and chronic lung disease. The long-term survival was also affected by logistic EuroSCORE (p < 0.02), occurrence of cardiac events (p < 0.001) as well as by newly developed renal insufficiency (p < 0.02), whereas the type of arterial graft did not influence neither the incidence of cardiac events nor the outcome (p = n.s.).

Conclusion: Long-term outcome following isolated CABG was mainly influenced by patient's comorbidities at time of surgery rather than by the choice of graft materials. Long-term survival was good, but the freedom from cardiac events was also heavily influenced by patient's comorbidities.