Does a third arterial conduit to the right coronary circulation improve survival?

The Journal of Thoracic and Cardiovascular Surgery

Maciej Matuszewski¹  Miguel M. Leiva-Juárez²  Suvitesh Luthra³ 

[1] Department of Cardiothoracic Surgery, New Cross Hospital, Wolverhampton, West Midlands, United Kingdom;Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, Tex;Division of Cardiac Surgery, Derriford Hospital, Plymouth, Devon, United Kingdom

关键词: coronary;    bypass;    arterial conduits;    right circulation;   

DOI  :  10.1016/j.jtcvs.2017.09.163

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

BackgroundThe long-term benefits of a third arterial conduit to the right circulation in triple-vessel disease remain debatable. This retrospective, single-center, propensity-matched study investigates the impact of a third arterial conduit to the right circulation on early and intermediate survival after coronary artery bypass grafting.MethodsData were retrospectively collected from 2004 to 2014 for all surgical revascularizations for triple-vessel disease with at least 2 arterial conduits to the left circulation and a third arterial or venous conduit to the right circulation. A total of 167 pairs were propensity matched to arterial versus venous third conduit to right circulation. Hazard functions were obtained with Cox multivariate regression and Kaplan-Meier survival curves were compared between the matched cohorts.ResultsExtracardiac arteriopathy, logistic euroSCORE, and left main stem disease were significant predictors of adverse survival. A third arterial conduit to the right circulation was not a significant predictor of improved survival in multivariate analysis (HR, 0.72; 95% CI, 0.34-1.55; P = .411). 30-day mortality was 0.6% in both groups. There was no significant difference in early or intermediate survival in the propensity-matched groups (venous vs arterial, 99.2% vs 99.2%; P = 1.000 at 1 year; 85.2% vs 88.8%; P = .248 at 5 years and 69.2% vs 88.8%; P = .297 at 7 years)ConclusionsThe use of a third arterial versus a venous conduit to the right circulation does not improve early or intermediate survival up to 7 years in triple-vessel coronary artery disease in this study. Longer follow-up and larger cohorts may be needed for differences to emerge.

【 授权许可】

Unknown