Excellent Results of Off-pump Coronary Artery Bypass Grafting using Skeletonized Multiarterial Graft
Kan Kajimoto, Atsushi Amano, Daisuke Endo, Yoichiro Machida, Jiyoung Lee, Akie Shimada, Kenji Kuwaki, Hiroaki Hata, Taira Yamamoto.
Juntendo University, Tokyo, Japan.
Background: Benefits of arterial graft in coronary artery bypass grafting were attracted renewed attention. Our current strategies for coronary artery bypass grafting (CABG) can achieve revascularization with skeletonized multiarterial grafts without cardiopulmonary bypass (OPCAB). Diabetes mellitus (DM) remains a strong risk factor for mortality and morbidity after CABG. The aim of this study was to assess the impact of our CABG strategies on long-term results, especially focused on patients with DM.
Methods: This study analyzed a prospective cohort from the Juntendo CABG registry included consecutive 1,942 patients who underwent isolated CABG between 2002 and 2013. The long-term outcomes were assessed between patents with and without DM.
Results: The mean follow-up period was 5.1±2.8 years. The prevalence of DM was 54%. Patients with DM were more likely to be older and have severe coronary artery disease, impaired cardiac function, impaired renal function and cerebrovascular disease. Our graft selection strategies were based on the frequently usage of arterial graft as many as possible. All arterial grafts were harvested by skeletonized fashion using ultrasound scalpel. Saphenous vein grafts were also used as additional graft if necessary. A left internal thoracic artery graft was used in almost all patients (96%). Other arterial grafts included the right ITA (58%), right gastroepiploic artery (36%), and radial artery (22%). Bilateral ITA, right gastroepiploic arteries were used more frequently in the DM group (54% vs. 61%; p<0.001, 32% vs. 40%; p<0.001). Number of distal anastomoses were significantly larger in DM patients (DM vs. non-DM, 3.2 ± 1.3 vs. 3.7 ± 1.3 ; p<0.001). The long-term all-cause mortality was significantly higher in DM patients than non-DM patients. However, the long-term cardiac mortality and incidence of major adverse cardiac event (MACE) was similar between DM and non-DM patients (hazard ratio (HR) 1.56; 95% confidence interval (CI) 0.54-4.06; p=0.41 and HR 1.17; 95% CI 0.70-1.98; p=0.55 respectively).
Conclusions: The adverse effect of DM on long-term cardiac mortality and incidence of MACE after CABG was counteracted by current CABG techniques, mainly driven by skeletonized multiarterial graft. Thus, we conclude that CABG using multiarterial grafts is an excellent strategy for diabetic patients.
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