Author + information
- Received April 22, 2018
- Revision received June 11, 2018
- Accepted June 19, 2018
- Published online September 10, 2018.
- Alistair G. Royse, MBBS, MDa,b,∗ (, )@AlistairRoyse@unimelb,
- Anthony P. Brennan, MDc,
- Jared Ou-Young, BSc, MScd,
- Zulfayandi Pawanis, MBiomedSce,
- David J. Canty, MBBS, PhDa,f and
- Colin F. Royse, MBBS, MDa,g
- aDepartment of Surgery, The University of Melbourne, Parkville, Victoria, Australia
- bDepartment of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- cSt. Vincent’s Hospital, Melbourne, Victoria, Australia
- dMedicalwriters.com, Zurich, Switzerland
- eUniversitas Airlangga Hospital, Universitas Airlangga, Surabaya, Indonesia
- fDepartment of Anaesthesia and Pain Management, Monash Medical Centre, Melbourne, Victoria, Australia
- gDepartment of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- ↵∗Address for correspondence:
Dr. Alistair G. Royse, The University of Melbourne, The Royal Melbourne Hospital, P.O. Box 2135, RMH, Melbourne, Victoria, 3050, Australia.
Background In 1999, Royse et al. reported on the left internal mammary artery, radial artery, Y-graft technique (LIMA-RA-Y), which achieves total arterial revascularization (TAR). However, the most common coronary reconstruction remains LIMA and supplementary saphenous vein grafts (LIMA + SVG).
Objectives The goal of this study was to conduct a survival comparison of LIMA-RA-Y versus the conventional LIMA + SVG.
Methods Of the original 464 LIMA-RA-Y patients reported (1996 to 1998), 346 were from the Royal Melbourne Hospital. Survival at June 2017 was compared with a group of 534 patients from 1996 to 2003 from the same institution who received LIMA + SVG, or 5,800 patients who received TAR with different grafting configurations. Propensity score matching (PSM) was performed with 1:1 matching using 26 variables. Comparisons used Kaplan-Meier (KM) and Cox proportional hazards methods. LIMA-RA-Y was compared with LIMA + SVG in which all non–left anterior descending artery grafts were performed with either composite RA or aorta-coronary SVG with no use of right internal mammary artery. We also conducted a comparison of LIMA-RA-Y versus TAR.
Results Baseline characteristics of the LIMA-RA-Y group (n = 346) compared with LIMA + SVG (n = 534) after PSM (n = 232 pairs) did not differ (3.3 ± 0.8 grafts per patient). Survival was worse for LIMA + SVG in the unmatched groups (KM, p < 0.001) and for PSM groups (KM, p = 0.043; Cox proportional hazards ratio: 1.3; 95% confidence interval: 1.0 to 1.6; p = 0.038). Survival did not differ between LIMA-RA-Y and other TAR (n = 5,800) patients before, or after, PSM (n = 332 pairs).
Conclusions Use of LIMA + SVG has worse survival than LIMA-RA-Y in achieving total arterial revascularization.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 22, 2018.
- Revision received June 11, 2018.
- Accepted June 19, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.