Comparison of total arterialized coronary artery bypass grafting and left internal mammary artery plus saphenous vein bypass grafting in three-vessel coronary heart disease patients with diabetes_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Yongyi ,  XUE Song , HUANG Ritai , XU Genxing , LIAN Feng , LI Wei

Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, P.R.China;

Corresponding author：

XUE Song, Email: xuesong64@163.com

Keywords：

Coronary artery disease; diabetes mellitus; total artery bypass grafting

DOI：

10.7507/1007-4848.202012050

Video：

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Objective To evaluate the perioperative, short- and mid-term results of total artery bypass grafting and saphenous vein bypass grafting in three-vessel coronary heart disease patients complicated with diabetes.Methods Retrospective analysis was performed on 46 patients (a TAR group) including 36 males and 10 females with an average age of 65.1±11.3 years who underwent total artery bypass grafting in Renji Hospital affiliated to Shanghai Jiao Tong University Medical College from 2005 to 2014. A total of 46 patients with age and gender matched admitted during the same period were selected as a control group (NCR group), in which left internal mammary artery and great saphenous vein were used as grafting vessels. Preoperative, perioperative, and postoperative (1 year and 5 years) data of the two groups were analyzed.Results In terms of perioperative data, the TAR group was inferior to the NCR group in operation time, postoperative 24 h drainage volume and postoperative 24 h blood transfusion volume. However, there was no difference between the two groups in terms of perioperative mortality, ICU stay, etc. One year after surgery, there was no difference in angina pectoris recurrence, recurrent myocardial infarction or grafting vessel patency rate between the two groups. Five years after the operation, the TAR group was superior to the NCR group in angina recurrence, myocardial infarction, and grafting vessels patency rate.Conclusion For patients with three-vessel coronary heart disease complicated with diabetes, total arterial bypass grafting can achieve better mid-term effect, although it can prolong the operation time and increase the amount of drainage and blood transfusion 24 h after operation.

1.	Raza S, Sabik JF, Ainkaran P, et al. Coronary artery bypass grafting in diabetics: A growing health care cost crisis. J Thorac Cardiovasc Surg, 2015, 150(2): 304-302.
2.	Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
3.	Weinschelbaum EE, Gabe ED, Macchia A, et al. Total myocardial revascularization with arterial conduits: Radial artery combined with internal thoracic arteries. J Thorac Cardiovasc Surg, 1997, 114(6): 911-916.
4.	Gaudino M, Puskas JD, Di Franco A, et al. Three arterial grafts improve late survival: A meta-analysis of propensity-matched studies. Circulation, 2017, 135(11): 1036-1044.
5.	Hirotani T, Nakamichi T, Munakata M, et al. Risks and benefits of bilateral internal thoracic artery grafting in diabetic patients. Ann Thorac Surg, 2003, 76(6): 2017-2022.
6.	Tatoulis J, Wynne R, Skillington PD, et al. Total arterial revascularization: A superior strategy for diabetic patients who require coronary surgery. Ann Thorac Surg, 2016, 102(6): 1948-1955.
7.	Choi JS, Cho KR, Kim KB. Does diabetes affect the postoperative outcomes after total arterial off-pump coronary bypass surgery in multivessel disease? Ann Thorac Surg, 2005, 80(4): 1353-1360.
8.	Raza S, Blackstone EH, Houghtaling PL, et al. Influence of diabetes on long-term coronary artery bypass graft patency. J Am Coll Cardiol, 2017, 70(5): 515-524.
9.	Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med, 2012, 367(25): 2375-2384.
10.	Farkouh ME, Domanski M, Dangas GD, et al. Long-term survival following multivessel revascularization in patients with diabetes: The FREEDOM follow-on study. J Am Coll Cardiol, 2019, 73(6): 629-638.
11.	Yilmaz MB, Guray U, Guray Y, et al. Metabolic syndrome negatively impacts early patency of saphenous vein grafts. Coron Artery Dis, 2006, 17(1): 41-44.
12.	Tatoulis J, Buxton BF, Fuller JA. The right internal thoracic artery: The forgotten conduit--5, 766 patients and 991 angiograms. Ann Thorac Surg, 2011, 92(1): 9-15.
13.	Hayward PA, Gordon IR, Hare DL, 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(1): 60-65.
14.	Ayan M, Saurav A, Kabach A. TCT-280 impact of diabetes mellitus on graft patency following coronary artery bypass graft surgery: A propensity score analysis. J Am Coll Cardiol, 2015, 66(Suppl 15): B110.
15.	Schwann TA, Gaudino M, Baldawi M, et al. Optimal management of radial artery grafts in CABG: Patient and target vessel selection and anti-spasm therapy. J Card Surg, 2018, 33(5): 205-212.
16.	Kunihara T, Wendler O, Heinrich K, et al. Coronary artery bypass grafting in diabetic patients: Complete arterial versus internal thoracic artery and sequential vein grafts-a propensity—score matched analysis. Thorac Cardiovasc Surg, 2019, 67(6): 428-436.

1. Raza S, Sabik JF, Ainkaran P, et al. Coronary artery bypass grafting in diabetics: A growing health care cost crisis. J Thorac Cardiovasc Surg, 2015, 150(2): 304-302.
2. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
3. Weinschelbaum EE, Gabe ED, Macchia A, et al. Total myocardial revascularization with arterial conduits: Radial artery combined with internal thoracic arteries. J Thorac Cardiovasc Surg, 1997, 114(6): 911-916.
4. Gaudino M, Puskas JD, Di Franco A, et al. Three arterial grafts improve late survival: A meta-analysis of propensity-matched studies. Circulation, 2017, 135(11): 1036-1044.
5. Hirotani T, Nakamichi T, Munakata M, et al. Risks and benefits of bilateral internal thoracic artery grafting in diabetic patients. Ann Thorac Surg, 2003, 76(6): 2017-2022.
6. Tatoulis J, Wynne R, Skillington PD, et al. Total arterial revascularization: A superior strategy for diabetic patients who require coronary surgery. Ann Thorac Surg, 2016, 102(6): 1948-1955.
7. Choi JS, Cho KR, Kim KB. Does diabetes affect the postoperative outcomes after total arterial off-pump coronary bypass surgery in multivessel disease? Ann Thorac Surg, 2005, 80(4): 1353-1360.
8. Raza S, Blackstone EH, Houghtaling PL, et al. Influence of diabetes on long-term coronary artery bypass graft patency. J Am Coll Cardiol, 2017, 70(5): 515-524.
9. Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med, 2012, 367(25): 2375-2384.
10. Farkouh ME, Domanski M, Dangas GD, et al. Long-term survival following multivessel revascularization in patients with diabetes: The FREEDOM follow-on study. J Am Coll Cardiol, 2019, 73(6): 629-638.
11. Yilmaz MB, Guray U, Guray Y, et al. Metabolic syndrome negatively impacts early patency of saphenous vein grafts. Coron Artery Dis, 2006, 17(1): 41-44.
12. Tatoulis J, Buxton BF, Fuller JA. The right internal thoracic artery: The forgotten conduit--5, 766 patients and 991 angiograms. Ann Thorac Surg, 2011, 92(1): 9-15.
13. Hayward PA, Gordon IR, Hare DL, 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(1): 60-65.
14. Ayan M, Saurav A, Kabach A. TCT-280 impact of diabetes mellitus on graft patency following coronary artery bypass graft surgery: A propensity score analysis. J Am Coll Cardiol, 2015, 66(Suppl 15): B110.
15. Schwann TA, Gaudino M, Baldawi M, et al. Optimal management of radial artery grafts in CABG: Patient and target vessel selection and anti-spasm therapy. J Card Surg, 2018, 33(5): 205-212.
16. Kunihara T, Wendler O, Heinrich K, et al. Coronary artery bypass grafting in diabetic patients: Complete arterial versus internal thoracic artery and sequential vein grafts-a propensity—score matched analysis. Thorac Cardiovasc Surg, 2019, 67(6): 428-436.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesComparison of total arterialized coronary artery bypass grafting and left internal mammary artery plus saphenous vein bypass grafting in three-vessel coronary heart disease patients with diabetes

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