Long Term Survival Benefits of Different Conduits Used in Coronary Artery Bypass Graft Surgery- A Single Institutional Practice Over 20 Years

Aziz Momin,1 Redoy Ranjan,1,2 Oswaldo Valencia,1 Adam Jacques,3 Pitt Lim,4 David Fluck,3 Tuan P Chua,5 Venkatachalam Chandrasekaran1 1Department of Cardiac Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK; 2Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh; 3Department of Cardiology, Ashford and St Peter’s Hospitals NHS Foundation Trust, London, UK; 4Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK; 5Department of Cardiology, Royal Surrey NHS Foundation Trust, London, UKCorrespondence: Aziz Momin, Consultant Cardiac Surgeon, St George’s University Hospitals NHS Foundation Trust, London, SW17 0QT, United Kingdom, Tel +447956336739, Email aziz.momin@stgeorges.nhs.ukObjective: This study determined hazard factors and long-term survival rate of total arterial coronary artery bypass graft surgery over 20 years in an extensively large, population-based cohort.Methods: A total of 2979 patients who underwent isolated CABG from April 1999 to March 2020 were studied in 4 groups- Group-A (bilateral internal mammary artery ± radial artery), Group-B (single internal mammary artery + radial artery ± saphenous vein), Group-C (single internal mammary artery ± saphenous vein; no radial artery), and Group-D (radial artery ± saphenous vein; no internal mammary artery). The study endpoints analysed the correlation between the number and types of grafts with the survival time following isolated CABG surgery.Results: The total arterial revascularization (Group A) group had an admirable mean long-term survival of ~19 years, compared to 18.6 years (Group B), 15.86 years (Group C), and 10.99 years (Group D). A Kaplan-Meier curve demonstrated confidence interval (CI) for study groups- (95% CI 18.33– 19.94), (95% CI 18.14– 19.06), (95% CI 15.40– 16.32), and (95% CI 9.61– 12.38) in Group A, B, C, D respectively. In the Holm-Sidak method analysis, significant associations existed between the number of arterial grafts and the long-term outcome. A statistically significant (P≤ 0.05) long-term survival advantage for arterial grafting was demonstrated, especially total arterial revascularisation over all other combinations except single internal mammary artery + radial artery grafting.Conclusion: In this series, over 20 years, total arterial CABG use has excellent long-term survival, achieving complete myocardial revascularisation. There is no significant difference between the BIMA group and SIMA with radial artery. However, there is a reduced survival with decreased use of arterial conduits.Keywords: coronary artery bypass graft, CABG, bilateral internal mammary artery, total arterial CABG, long term outcome, multiple arterial graft, mortality, survival benefits