Complete Revascularization of the Three-Vessel Territories Using a Left Internal Thoracic Artery Composite Graft

Abstract

We evaluated whether revascularization using a Y-composite graft based on the left internal thoracic artery (ITA) is sufficient for patients with 3-vessel disease. Of 542 patients who underwent complete revascularization for 3-vessel disease, patients who received either single inflow from a left ITA-based Y-composite graft (group S, n = 297) or who received multiple inflows (including bilateral in situ ITAs, in situ right gastroepiploic artery, or aortocoronary grafts) (group M, n = 245) were compared. Clinical outcomes and myocardial perfusion improvement during the first postoperative year were studied. Baseline differences between groups were adjusted by inverse probability of treatment weighting (IPTW). Median follow-up duration was 94 (2 to 176) months. There were no differences in early mortality (4 of 297 vs 4 of 245; p > 0.999) and morbidity rates between the 2 groups, except atrial fibrillation (which was higher in group S than in group M; p < 0.001). There were no differences between the 2 groups in IPTW-adjusted overall survival, freedom from cardiac death, and freedom from major adverse cardiac and cerebrovascular events at 5 and 10 years (group S, 85.2% and 76.2% vs group M, 88.6% and 74.1%, p = 0.990). The IPTW-adjusted Cox proportional hazard model demonstrated that age (p = 0.030) and aortocoronary saphenous vein grafting (p = 0.002) were risk factors for major adverse cardiac and cerebrovascular events. Myocardial single photon emission computed tomography performed preoperatively, and 3 months and 1 year postoperatively demonstrated similar patterns of myocardial perfusion improvement between the 2 groups (p = 0.483). Revascularization using a Y-composite graft based on the left ITA for single inflow was sufficient for patients with 3-vessel disease in terms of early and long-term clinical outcomes and myocardial perfusion improvement.