Total Arterial Grafts in Coronary Bypass: A Comparative Study after Five Years Outcome

Purpose of Study: The conduits of choice for coronary revascularization in coronary artery bypass grafting (CABG) is an ongoing discussion among surgical practitioners. The paradigm shift in current studies is inclining towards the approach of total arterial grafting (TAG) as superior in long term outcomes when compared to multiple arterial grafts (MAG) or single arterial grafts (SAG) with vein grafting. However, TAG has not become the standard of care till present-day. In this study, we assessed the major adverse cardiac events (MACE), New York Heart Association Classification (NYHA) and Canadian Cardiovascular Society (CCS) classification as composite endpoint of TAG versus non-TAG post five years CABG. Methods: A retrospective cohort study is designed to evaluate the outcomes of TAG when compared to non-TAG approaches in patients who underwent CABG in Hospital Pulau Pinang (HPP) between 2015 to 2017. A total of 44 (11 TAG and 33 non-TAG) patients are enrolled in the study with comparable preoperative variables. The mean age is 53.6 ± 5.43 years, with the age range 41 – 60 years. All participants are from gender male with comorbidities of diabetes mellitus, hypertension and dyslipidemia. Operative technique of median sternotomy with either on pump or off pump CABG is employed in both TAG and non-TAG group. The conduits of choice in this study are combinations of bilateral internal mammary artery (BIMA), left internal mammary artery (LIMA), and radial artery (RA) for TAG group with concomitant use of saphenous vein (SV) in non-TAG group. Univariate analysis and comparison between the two clinical groups are performed. Results: Patients were followed up to assess the clinical outcome following CABG. TAG reported better NYHA symptoms control (p=0.04) with no statistically significance difference between both groups in CCS classification and MACE incidence. It is essential to note the statistical limitation due to small sample size available for study. Conclusion: Tot