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

Abstract

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. 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. 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. 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.