Arterial graft choice and outcomes within the Veterans Administration: A 20-year review of 47,525 patients.

Abstract

There is increasing interest in expanding the use of multiarterial grafting (MAG) in coronary artery bypass grafting due to improved long-term patency rates and outcomes. These outcomes have not been reviewed extensively in veterans. Using the Veterans Affairs Corporate Data Warehouse, veterans who underwent coronary artery bypass grafting surgery using cardiopulmonary bypass within the Veterans Administration hospital system from October 1, 2003, through September 30, 2023, were analyzed. Propensity score matching compared survival in patients undergoing single artery grafting (SAG) versus MAG. A total of 47,525 veterans were identified. One thousand eighty-four patients underwent internal thoracic artery and radial artery grafting, 2549 underwent bilateral internal thoracic artery grafting, and 43,892 underwent single internal thoracic artery grafting. Propensity score matching yielded 3286 pairs. In these matched patients, there was no difference in 30-day mortality: 1.31% MAG versus 1.34% SAG (P = 1.00). By 5 years, this diverged with a statistically significant lower mortality noted with MAG (14.1%) compared with SAG (16.3%) (P = .018). This trend continued at 10 years (27.1% vs 32.2%; P < .001) and 15 years (36.7% vs 41.7%; P < .001), all favoring MAG. Rates of 30-day myocardial infarction remained slightly higher with SAG (3.68%) versus MAG (2.98%) (P = .130). There was no difference in 30-day percutaneous coronary intervention (0.70% MAG vs 0.70% SAG; P = 1.00) or cerebrovascular events (1.67% MAG vs 2.07% SAG; P = .275). MAG is feasible and safe within the Veterans Administration population. Compared with SAG, MAG in veterans is associated with improved mortality beginning at 5 years postoperatively.