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Randomized Controlled Trial
. 2023 Apr 3;63(4):ezad060.
doi: 10.1093/ejcts/ezad060.

Anterolateral territory coronary artery bypass grafting strategies: a non-inferiority randomized clinical trial: the AMI-PONT trial

Louis-Mathieu Stevens  1   2 , Carl Chartrand-Lefebvre  2   3 , Samer Mansour  2   4 , Vincent Béland  2 , Gilles Soulez  2   3 , Jessica Forcillo  1   2 , Fadi Basile  1 , Ignacio Prieto  1 , Nicolas Noiseux  1   2
Affiliations
Randomized Controlled Trial

Anterolateral territory coronary artery bypass grafting strategies: a non-inferiority randomized clinical trial: the AMI-PONT trial

Louis-Mathieu Stevens et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: The main objective was to assess whether a composite coronary artery bypass grafting strategy including a saphenous vein graft bridge to distribute left internal mammary artery outflow provides non-inferior patency rates compared to conventional grafting surgery with separated left internal mammary artery to left anterior descending coronary graft and aorto-coronary saphenous vein grafts to other anterolateral targets.

Methods: All patients underwent isolated grafting surgery with cardiopulmonary bypass and received ≥2 grafts/patients on the anterolateral territory. The graft patency (i.e. non-occluded) was assessed using multislice spiral computed tomography at 1 year.

Results: From 2012 to 2021, 208 patients were randomized to a bridge (n = 105) or conventional grafting strategy (n = 103). Patient characteristics were comparable between groups. The anterolateral graft patency was non-inferior in the composite bridge compared to conventional grafting strategy at 1 year [risk difference 0.7% (90% confidence interval -4.8 to 6.2%)]. The graft patency to the left anterior descending coronary was no different between groups (P = 0.175). Intraoperatively, the bridge group required shorter vein length for anterolateral targets (P < 0.001) and exhibited greater Doppler flow in the mammary artery pedicle (P = 0.004). The composite outcome of death, myocardial infarction or target vessel reintervention at 30 days was no different (P = 0.164).

Conclusions: Anterolateral graft patency of the composite bridge grafting strategy is non-inferior to the conventional grafting strategy at 1 year. This novel grafting strategy is safe, efficient, associated with several advantages including better mammary artery flow and shorter vein requirement, and could be a valuable alternative to conventional grafting strategies. Ten-year clinical follow-up is underway.

Trial registration: ClinicalTrials.gov: NCT01585285.

Keywords: Cardiopulmonary bypass; Coronary artery bypass grafting; Multislice computed tomography angiography; Randomized clinical non-inferiority trial.

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Figures

Figure 1:
Figure 1:
CONSORT flow diagram. CPB: cardiopulmonary bypass; eGFR: estimated glomerular filtration rate; LVEF: left ventricular ejection fraction.
Figure 2:
Figure 2:
Anterolateral CABG techniques for the randomized groups. (A) LSVB CABG strategy: The in situ LIMA and a SVG bridge are used compositely to distribute the LIMA flow to the anterolateral territory. (B) Conventional CABG strategy: The in situ LIMA is directly anastomosed to the LAD and a separated aorto-coronary SVG is anastomosed to the anterolateral target(s) other than the LAD. Magnified details of the distal anastomoses are provided in the left upper corner of both figures, and distal portions of the LIMA pedicles has been graphically removed to present a better view of the distal anastomoses (adapted from Drouin et al. [10]).
Figure 3:
Figure 3:
Principal outcome for graft patency and subgroup analyses. Anterolateral graft patency differences between the LSVB vs conventional CABG are presented with their point estimates and 90% confidence interval for the overall trial (principal outcome), secondary outcomes and subgroup analyses. The –5% non-inferiority margin is presented with a dashed red line.
None
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References

    1. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM. et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022;145:e18–114. - PubMed
    1. Taggart DP, Altman DG, Gray AM, Lees B, Nugara F, Yu LM. et al.; ART Investigators. Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). Eur Heart J 2010;31:2470–81. - PubMed
    1. Hayward PA, Gordon IR, Hare DL, Matalanis G, Horrigan ML, Rosalion A. et al. Comparable patencies of the radial artery and right internal thoracic artery or saphenous vein beyond 5 years: results from the Radial Artery Patency and Clinical Outcomes trial. J Thorac Cardiovasc Surg 2010;139:60–5; discussion 65–7. - PubMed
    1. Nasso G, Coppola R, Bonifazi R, Piancone F, Bozzetti G, Speziale G.. Arterial revascularization in primary coronary artery bypass grafting: direct comparison of 4 strategies—results of the Stand-in-Y Mammary Study. J Thorac Cardiovasc Surg 2009;137:1093–100. - PubMed
    1. Gaudino M, Lorusso R, Rahouma M, Abouarab A, Tam DY, Spadaccio C. et al. Radial artery versus right internal thoracic artery versus saphenous vein as the second conduit for coronary artery bypass surgery: a network meta-analysis of clinical outcomes. J Am Heart Assoc 2019;8:e010839. - PMC - PubMed

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