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Thorac Cardiovasc Surg 2025; 73(08): 625-632
DOI: 10.1055/a-2446-9960
Original Cardiovascular

The Impact of Multiarterial Grafting in Patients with Left Ventricular Dysfunction

Authors

  • Tom Ronai

    1   Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel
    2   The Ruth and Baruch Rappaport faculty of medicine, Technion, Haifa, Israel

  • Dana Abraham

    1   Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel
    2   The Ruth and Baruch Rappaport faculty of medicine, Technion, Haifa, Israel

  • Ely Erez

    3   Division of Cardiac Surgery, Yale University, New Haven, Connecticut, United States

  • Guy Witberg

    4   Department of Cardiology, Rabin Medical Center, Petah Tikva, Central, Israel

  • Yaron Yishai

    5   Department of Cardiac Surgery, Soroka Medical Center, Beer Sheva, Southern, Israel

  • Erez Sharoni

    1   Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel

  • Dror B. Leviner 

    1   Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel
    2   The Ruth and Baruch Rappaport faculty of medicine, Technion, Haifa, Israel
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Abstract

Background

Coronary artery bypass grafting (CABG) is one of the revascularization modalities available in patients with left ventricular dysfunction (LVD). Multiple arterial grafting (MAG) is associated with improved long-term outcomes. Data on the benefits of MAG in patients with LVD are limited. We examined the effect of MAG on outcomes across the spectrum of left ventricle (LV) function.

Methods

Retrospective cohort study of patients undergoing isolated CABG (January 1, 2009, to October 1, 2021). Patients were grouped according to revascularization strategy (single vs. MAG). The primary outcome was a composite of all-cause mortality, cerebrovascular accident, myocardial infarction, and repeat revascularization (major adverse cardiac and cerebrovascular events [MACCE]). The cumulative incidence of MACCE was plotted using Kaplan–Meier curves. Results were stratified according to LV function (<30%, 30–50%, >50%).

Results

Our cohort included 4,763 patients; 1,976 (41.4%) underwent single arterial grafting (SAG), and 2,787 (58.6%) underwent MAG; 3,976 (83.4%) were male with a median age of 64 (interquartile range [IQR] 57–71) years. Distribution of LV function was 2,539 (53.3%) with an ejection fraction (EF) >50%, 1,828 (38.3%) with an EF of 30–50%, and 396 (8.3%) with an EF <30%. Median follow-up time was 64 (37–102) months. Cumulative incidence of MACCE at 72 months was 28.7% in the MAG and 30.3% in the SAG group. Stratified by LV function, the hazard ratio for MACCE at 160 months was 0.71 (95% CI 0.54–0.93), 0.78 (95% CI 0.68–0.9), and 0.95 (95% CI 0.83–1.09) for LV function <30%, 30–50%, >50%, respectively, with no significant interaction between MAG and LV function.

Conclusion

MAG is associated with improved outcomes following CABG across the spectrum of LV function.

Keywords

multiarterial grafting - coronary artery bypass grafting - left ventricular dysfunction

Data Availability Statement

The data underlying this article will be shared on reasonable request to the corresponding author.




Publication History

Received: 09 July 2024

Accepted: 16 October 2024

Article published online:
21 November 2024

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