Choice of conduit for coronary artery bypass grafting in poor ventricles

Abstract

Background: advantages in the use of arterial grafts for coronary artery revascularizations have been reported previously. Objectives: we aimed to compare the outcome and survival rates of different conduits in patients with poor ventricular function (ejection fraction <30%). Methods: in a 10-year period, 979 patients with an ejection fraction <30%, who underwent isolated first-time coronary artery bypass grafting, were divided into in 3 groups: (A) total arterial grafts ( n = 257), (B) total vein grafts ( n = 76), and (C) left internal mammary artery and vein grafts ( n = 610). Multivariate logistic regression was used to assess the effect of graft type on mortality, while adjusting for patient and disease characteristics. Hospital mortality and 5-year survival rates were compared among the groups. Results: hospital mortality was 8.9% for group A, 11.8% for group B, and 5.7% for group C. Mortality at 5 years was 27.2% for group A, 42.3% for group B, and 28.7% for group C. After risk adjustment, hospital mortality and mid- and long-term mortality showed no significant differences among the groups. Conclusions: patients with poor ventricular function have a high mortality rate in both the short- and long-term with any type of conduit. Mortality rates with total arterial grafts and vein plus arterial grafts were comparable before and after risk adjustment.