Impact of Total Arterial Reconstruction on Long-Term Mortality and Morbidity: Off-Pump Total Arterial Reconstruction Versus Non-Total Arterial Reconstruction

Abstract

Background: We were interested in how favorable an influence total arterial reconstruction has on the clinical outcome of patients undergoing off-pump coronary artery bypass graft surgery.

Methods: From January 2002 to December 2013, a total of 1,064 patients underwent isolated off-pump coronary artery bypass graft surgery at our institution. Of these 1,064 patients, 763 underwent total arterial revascularization (AR) and 301 underwent a combination of artery and vein revascularization (AVR). We compared the clinical results between the two groups using the propensity score matching technique.

Results: In all, 260 cases from the AVR group and 520 from the AR group were successfully matched. All procedures were performed using the off-pump technique without conversion to on-pump. Eight patients in the AVR group (3.1%) and 5 in the AR group (1.0%) died in hospital. Multivariate analysis revealed that chronic kidney disease (odds ratio 6.9, p < 0.001), urgency (odds ratio 7.3, p < 0.001), and body mass index (odds ratio 1.3, p = 0.02) were independent risk factors for hospital death. Follow-up was complete for 97.6% of the patients to a maximum of 13 years. According to the Kaplan-Meier method, the rate of 12-year freedom from all causes of death was 69.7% for the AVR group and 72.6% for the AR group (p = 0.002), and the corresponding rates for major adverse cardiac events were 83.9% and 87.7% (p = 0.009). By multivariate Cox regression analysis, total arterial reconstruction was identified as a preventive factor for late cardiac events.

Conclusions: Total arterial revascularization has some degree of favorable effect on the long-term clinical outcome of patients undergoing off-pump coronary artery bypass graft surgery.