Impact of More Than 1 Distal Anastomosis on the Same Territory in 3-Vessel Disease Patients

Abstract

Background: Previous studies defined complete revascularization as the placement of at least 1 bypass graft to each diseased coronary territory. This study was conducted to evaluate whether putting more than 1 graft to each diseased coronary territory is beneficial for patients with 3-vessel disease (3VD) who underwent coronary artery bypass grafting (CABG). Methods: Among 1859 patients who underwent primary isolated CABG, 1008 patients (male-to-female ratio, 841:239; mean age, 67.0 ± 9.3 years) who underwent OPCAB for 3VD and in whom complete revascularization was achieved were retrospectively enrolled. Complete revascularization was defined as at least 1 graft to each coronary artery territory. The median follow-up duration was 86.6 months (interquartile range, 53.0-126.9). Results: A total of 829 patients (82.2%) had more than 3 distal anastomoses, whereas the other 179 patients had 3 distal anastomoses. Hypertension (n = 729; 72.3%) and diabetes (n = 556; 55.2%) were the most common comorbidities without any intergroup differences. The early mortality rate was 1.0% (n = 10). Late death occurred in 337 of 998 early survivors. Five- and 10-year all-cause mortality rates were 18.0% and 36.0%, respectively. Cumulative incidences of cardiac deaths were 5.2% and 9.2%, respectively. The inverse probability treatment weighting–adjusted multivariate analyses showed that having more than 3 distal anastomoses was associated with lower all-cause mortality and cardiac death (hazard ratio, 0.76 [95% CI, 0.57-0.99] and hazard ratio, 0.50 [95% CI, 0.31-0.83], respectively). Conclusions: Grafting more than 1 diseased vessel in each diseased coronary territory during CABG may be beneficial for patients with 3VD in terms of all-cause mortality and cardiac death.