Prognostic factors and outcome in patients submitted into coronary artery bypass surgery with total arterial myocardial revascularization

Background: Coronary artery bypass grafting relieves symptoms and improves survival in patients with severe coronary artery disease. Large series and meta-analyses show that total arterial myocardial revascularization (TAMR) may offer additional survival benefit. The primary objective of this study was to investigate long-term (>5 years) survival of patients undergoing TAMR. The change in coronary artery disease risk factors during the follow-up period was also evaluated.
Methods: Forty patients undergoing coronary artery bypass grafting (CABG) with total arterial myocardial revascularization (TAMR) were studied. All patients were screened for coronary artery disease risk factors at entry and follow-up. Repeat coronary angiography at a 5-year follow-up was used to investigate the long-term patency of arterial grafts.
Results: Mean patient EuroSCORE was 1.42±1.1%. Mean follow-up time was 9.3±4.8 years (range: 1 month to 15.6 years). The 30-day mortality was 2.5% (1/40 patients), while the 12-month mortality was 7.5% (3/40 patients) with an actual survival of 92.5%. The 5-year and 10-year mortality was 15.8% (6/38 patients) and 33.3% (10/30 patients) respectively, while actual survival reached 84.2% and 66.7% at 5 and 10 years respectively. A total of 10/40 patients (25%) died during follow-up. Mean time-to-event was 3.5±2.7 years (range: one month to 7.1 years); 40% of deaths occurred during the first 2 years from the procedure, and 40% occurred during the period from 4.5 to 6.5 years post-surgery. The main cause of death was cerebrovascular disease in 30% of patients, while 20% died of cancer. 40% of fatalities were cardiac-related but not due to ischemic heart disease. The incidence of major adverse cardiac and cerebrovascular events (a composite outcome of cardiac-related death, myocardial infarction, need for revascularization and stroke) was 17.5% during follow-up. Total morbidity reached 30%. The use of the radial artery resulted in a similar survival to the use of bilateral internal mammary arteries exclusively. The numbers of grafts used were 39 Left internal mammary artery grafts (LIMA), 34 right internal mammary artery grafts (RIMA) and 24 right radial artery grafts (RAD). Repeat coronary angiography at a 5-year follow-up revealed that all arterial grafts were patent. Control of arterial hypertension (blood pressure <30/80 mmHg) was achieved in 65% of patients postoperatively compared to 22.5% preoperatively (p=0.01).
Conclusions: TAMR is safe and effective with encouraging results in terms of long-term survival. This is the first reported study investigating long-term outcomes in patients undergoing total arterial revascularization in Greece.