SINGLE VERSUS MULTIPLE ARTERIAL GRAFTS: COMPARISON OF IN HOSPITAL MORTALITY

Authors

  • W KHALID Department of cardiac surgery, Rehmatul Lil Alameen Institute of Cardiology (RAIC), Lahore- Pakistan
  • H IQBAL Department of cardiac surgery, Rehmatul Lil Alameen Institute of Cardiology (RAIC), Lahore- Pakistan
  • M AAMIR Department of cardiac surgery, Jinnah Hospital, Lahore-Pakistan
  • T INAM Department of Anatomy, kind Edward Medical University (KEMU) Lahore- Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2022i1.150

Keywords:

single, multiple, arterial grafts, Coronary artery bypass grafting, Coronary artery disease, In-hospital, mortality

Abstract

Even though not all findings have been equally positive, many retrospective studies seem to have shown an incremental survival improvement by increasing the number of arterial grafts. Multiple arterial (MultArt) grafting is only currently used in a small number of coronary arteries bypass grafting (CABG) surgeries, despite the convincing and comprehensive information in the published literature. The goal of the study is to compare the incidence of in-hospital mortality in patients following CABG with single versus multiple arterial grafts and to evaluate the frequency of single and multiple CABG arterial grafts in patients undergoing CABG for coronary arteries diseases (CAD). Following institutional review board permission, this descriptive case series was carried out at Jinnah Hospital's heart surgery department in Lahore. 250 patients receiving CABG under general anaesthesia were a part of this study. The quantity of arteries grafted was recorded during CABG. It was observed whether there were one or several arterial grafts. A single surgical team carried out every procedure, under general anaesthesia. Patients were moved to post-surgical wards after surgery. Following surgery, patients were monitored there for 7 days. In-hospital mortality is defined as when a patient dies while receiving treatment in the hospital. In this study, inpatient mortality affected 7 (or 5.9%) of patients treated with single grafts and just 1 (or 0.8%) of patients treated with multiple grafts (p=0.022). Patients who received single graft CABG had a considerably greater incidence of in-hospital mortality. The superiority of multiple arterial graft CABG in terms of lower hospital mortality rate was demonstrated by the study's findings.

Downloads

Download data is not yet available.

References

Bundhun, P. K., Wu, Z. J., and Chen, M.-H. (2016). Coronary artery bypass surgery compared with percutaneous coronary interventions in patients with insulin-treated type 2 diabetes mellitus: a systematic review and meta-analysis of 6 randomized controlled trials. Cardiovascular Diabetology15, 1-10.

Buszman, P. E., Kiesz, S. R., Bochenek, A., Peszek-Przybyla, E., Szkrobka, I., Debinski, M., Bialkowska, B., Dudek, D., Gruszka, A., and Zurakowski, A. (2008). Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization. Journal of the American College of Cardiology51, 538-545.

Dewar, L. R., Jamieson, W. E., Janusz, M. T., Adeli-Sardo, M., Germann, E., MacNab, J. S., and Tyers, G. F. O. (1995). Unilateral versus bilateral internal mammary revascularization: survival and event-free performance. Circulation92, 8-13.

Elghobary, T., and Légaré, J.-F. (2010). What has happened to multiple arterial grafting in coronary artery bypass grafting surgery? Expert Review of Cardiovascular Therapy8, 1099-1105.

Guru, V., Fremes, S. E., and Tu, J. V. (2006). How many arterial grafts are enough? A population-based study of midterm outcomes. The Journal of thoracic and cardiovascular surgery131, 1021-1028.

Habib, R. H., Dimitrova, K. R., Badour, S. A., Yammine, M. B., El-Hage-Sleiman, A.-K. M., Hoffman, D. M., Geller, C. M., Schwann, T. A., and Tranbaugh, R. F. (2015). CABG versus PCI: greater benefit in long-term outcomes with multiple arterial bypass grafting. Journal of the American College of Cardiology66, 1417-1427.

Kappetein, A. P., Feldman, T. E., Mack, M. J., Morice, M.-C., Holmes, D. R., Ståhle, E., Dawkins, K. D., Mohr, F. W., Serruys, P. W., and Colombo, A. (2011). Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. European heart journal32, 2125-2134.

Kapur, A., Hall, R. J., Malik, I. S., Qureshi, A. C., Butts, J., de Belder, M., Baumbach, A., Angelini, G., de Belder, A., and Oldroyd, K. G. (2010). Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients: 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial. Journal of the American College of Cardiology55, 432-440.

Kim, Y.-G., Park, D.-W., Lee, W. S., Park, G.-M., Sun, B. J., Lee, C. H., Hwang, K. W., Cho, S. W., Kim, Y. R., and Song, H. G. (2012). Influence of diabetes mellitus on long-term (five-year) outcomes of drug-eluting stents and coronary artery bypass grafting for multivessel coronary revascularization. The American journal of cardiology109, 1548-1557.

Kurlansky, P. A., Traad, E. A., Dorman, M. J., Galbut, D. L., Zucker, M., and Ebra, G. (2010). Thirty-year follow-up defines survival benefit for second internal mammary artery in propensity-matched groups. The Annals of thoracic surgery90, 101-108.

Locker, C., Schaff, H. V., Daly, R. C., Dearani, J. A., Bell, M. R., Frye, R. L., Greason, K. L., Stulak, J. M., Joyce, L. D., and Pochettino, A. (2016). Multiple arterial grafts improve survival with coronary artery bypass graft surgery versus conventional coronary artery bypass grafting compared with percutaneous coronary interventions. The Journal of thoracic and cardiovascular surgery152, 369-379. e4.

Natsuaki, M., Morimoto, T., Furukawa, Y., Nakagawa, Y., Kadota, K., Yamaji, K., Ando, K., Shizuta, S., Shiomi, H., and Tada, T. (2014). Late adverse events after implantation of sirolimus-eluting stent and bare-metal stent: Long-term (5–7 years) follow-up of the Coronary Revascularization Demonstrating Outcome study-Kyoto registry Cohort-2. Circulation: Cardiovascular Interventions7, 168-179.

Petrosian, K. (2018). Multidisciplinary approach in a Heart Team concept–direct strategy in optimization of treatment for coronary lesions. Russian Journal of Thoracic and Cardiovascular Surgery60, 287-93.

Rankin, J. S., Tuttle, R. H., Wechsler, A. S., Teichmann, T. L., Glower, D. D., and Califf, R. M. (2007). Techniques and benefits of multiple internal mammary artery bypass at 20 years of follow-up. The Annals of thoracic surgery83, 1008-1015.

Rizzoli, G., Schiavon, L., and Bellini, P. (2002). Does the use of bilateral internal mammary artery (IMA) grafts provide incremental benefit relative to the use of a single IMA graft? A meta-analysis approach. European journal of cardio-thoracic surgery22, 781-786.

Ruttmann, E., Fischler, N., Sakic, A., Chevtchik, O., Alber, H., Schistek, R., Ulmer, H., and Grimm, M. (2011). Second internal thoracic artery versus radial artery in coronary artery bypass grafting: a long-term, propensity score–matched follow-up study. Circulation124, 1321-1329.

Schwann, T. A., Al-Shaar, L., Engoren, M., and Habib, R. H. (2013). Late effects of radial artery vs saphenous vein grafting for multivessel coronary bypass surgery in diabetics: a propensity-matched analysis. European Journal of Cardio-Thoracic Surgery44, 701-710.

Taggart, D. P., Lees, B., Gray, A., Altman, D. G., Flather, M., and Channon, K. (2006). Protocol for the Arterial Revascularisation Trial (ART). A randomised trial to compare survival following bilateral versus single internal mammary grafting in coronary revascularisation [ISRCTN46552265]. Trials7, 1-11.

Tranbaugh, R. F., Dimitrova, K. R., Friedmann, P., Geller, C. M., Harris, L. J., Stelzer, P., Cohen, B., and Hoffman, D. M. (2010). Radial artery conduits improve long-term survival after coronary artery bypass grafting. The Annals of thoracic surgery90, 1165-1172.

Verma, S., Farkouh, M. E., Yanagawa, B., Fitchett, D. H., Ahsan, M. R., Ruel, M., Sud, S., Gupta, M., Singh, S., and Gupta, N. (2013). Comparison of coronary artery bypass surgery and percutaneous coronary intervention in patients with diabetes: a meta-analysis of randomised controlled trials. The lancet Diabetes & endocrinology1, 317-328.

Weintraub, W. S., Grau-Sepulveda, M. V., Weiss, J. M., O'Brien, S. M., Peterson, E. D., Kolm, P., Zhang, Z., Klein, L. W., Shaw, R. E., and McKay, C. (2012). Comparative effectiveness of revascularization strategies. New England Journal of Medicine366, 1467-1476.

Zacharias, A., Habib, R. H., Schwann, T. A., Riordan, C. J., Durham, S. J., and Shah, A. (2004). Improved survival with radial artery versus vein conduits in coronary bypass surgery with left internal thoracic artery to left anterior descending artery grafting. Circulation109, 1489-1496.

Downloads

Published

2022-11-22

How to Cite

KHALID, W., IQBAL, H., AAMIR, M., & INAM, T. (2022). SINGLE VERSUS MULTIPLE ARTERIAL GRAFTS: COMPARISON OF IN HOSPITAL MORTALITY. Biological and Clinical Sciences Research Journal, 2022(1). https://doi.org/10.54112/bcsrj.v2022i1.150

Issue

Section

Original Research Articles

Most read articles by the same author(s)