Performance of left internal thoracic artery-left anterior descending artery anastomosis by residents versus attendings and coronary artery bypass grafting outcomes.

Abstract

Performance of a technically sound Left Internal Thoracic Artery to Left Anterior Descending Artery (LITA-LAD) anastomosis during coronary artery bypass grafting (CABG) is critically important. We investigated CABG outcomes according to whether a resident or attending surgeon performed the LITA-LAD anastomosis using prospectively collected data from the multicenter, randomized REGROUP (Randomized Endograft Vein Perspective) Trial. This was a posthoc subanalysis of the REGROUP trial, which randomized veterans undergoing isolated on-pump CABG to endoscopic versus open vein harvest between 2014-2017. The primary endpoint was major cardiac adverse events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or repeat revascularization. Among 1,084 patients, 344 (31.8%) LITA-LAD anastomoses were performed by residents and 740 (68.2%) by attending surgeons. Residents (when compared to attendings) operated on fewer patients with high tercile SYNTAX scores (22.1% vs. 37.4%, p < 0.001), performed less multiarterial CABG (5.2% vs. 14.6%, p < 0.001), and performed more anastomoses to distal targets with diameters > 2.0 mm (19.0% vs. 10.9%, p < 0.001) and non-calcified landing zones (25.1% vs. 21.6%, p < 0.001). During a median observation time of 4.7 years (interquartile range 3.84-5.45), MACE occurred in 77 patients (22.4%) in the resident group and 169 patients (22.8%) in the attending group (unadjusted HR 1.00; 95% confidence interval, 0.76-1.33; p = 0.99). Outcomes persisted on adjusted analyses. Based on this REGROUP trial subanalysis, under careful supervision and with appropriate patient selection, LITA-LAD anastomoses performed by residents yields similar clinical outcomes compared to attendings.