Autoarterial revascularization of myocardium involving Y-composite grafts and in situ conduits of the internal thoracic arteries: randomized controlled trial, hospital and mid-term outcomes

Objective: The aim of this study was to evaluate the outcomes of autoarterial revascularization involving Y-composite grafts and in situ conduits out of the internal thoracic arteries (ITAs) at the hospital period and after a year follow-up.Methods: The study included 200 patients with coronary artery disease who underwent coronary bypass surgery over the period from March 2018 to March 2021. Patients were randomized using the envelope method into 2 groups: in the first group, autoarterial conduits out of the ITAs were used according to the in situ method (n = 100); in the second group, autoarterial conduits with the formation of a Y-composite grafts out of ITAs (n = 100) were put into practice. The primary endpoints of the study were the incidence of repeat revascularization and amount of major adverse cardiac and cerebrovascular events (MACCE).Results: There was no significant difference between the two groups in the level of freedom from MACCE; in the in situ and Y-composite groups the indicators were 97.9% (95% CI 92.1-99.5) and 94.8% (95% CI 88.1‑97.8; P = 0.24), respectively. In a year follow-up, freedom from repeated revascularization amounted to 97.9% in the in situ group (95% CI 92-99.4), and 97.9% in the Y-composite group (95% CI 91.9-99.4; P = 0.97). A significant difference was registered in the surgery duration, which in the in situ group lasted 235 [197.5; 252.5] minutes versus 252.5 [225; 290] minutes in the Y-composite group, P < 0.002. In the Y-composite group, the rate of infectious complications on the breast bone was significantly more frequent than in the in situ group (P < 0.023).Conclusion: Despite the hypothetical advantages of bimammar coronary bypass surgery over the Y-configuration one, this study did not reveal significant differences in outcomes between the in situ and Y-composite groups. Received 7 November 2023. Revised 10 June 2024. Accepted 24 June 2024. FundingThe study did not have sponsorship. Conflict of interestThe authors declare no conflict of interest. Contribution of the authorsConception and study design: A.K. Sabetov, D.S. Khvan, M.O. ZhulkovData collection and analysis: A.K. SabetovStatistical analysis: A.A. Shadanov, A.K. SabetovDrafting the article: A.K. SabetovCritical revision of the article: D.A. Sirota, D.S. Khvan, A.M. ChernyavskiyFinal approval of the version to be published: A.K. Sabetov, D.A. Sirota, D.S. Khvan, M.O. Zhulkov, A.A. Shadanov, A.M. Chernyavskiy