CORONARY-BYPASS WITH ARTERIAL CONDUITS

To assess the efficacy of arterial revascularization 368 patients were studied who underwent myocardial revascularization with two or more a rterial conduits (group M) and compared with 2092 patients in whom a s ingle internal mammary artery +/- veins (group S), and to a third grou p in which only saphenous vein conduits (group V, n = 602) were used. Group M patients were younger (aged 54.0(9.5) years: 4.1% aged > 70 ye ars) than either group V (67.6(8.9) years, 40.7% > 70 years, P < 0.000 1) or group S patients (62.0(8.5) years, 15.7% > 70 years, P < 0.0001) . Furthermore, this cohort group had the lowest percentage of females (8.4%), of urgent cases (21.7%), of preoperative myocardial infarction (6.0%), and of redo surgery (0.8%), In contrast, patients who receive d only saphenous vein conduits had the highest proportion of female pa tients (29.2%), of urgent cases (47.4%), of preoperative myocardial in farction (16.5%), and of redo surgery (5.5%). By multivariate logistic regression analysis (odds ratio in parentheses), redo surgery (6.06, P= 0.0001), preoperative intra-aortic balloon pump assist (6.11, P = 0 .0001), diabetes (1.97, P = 0.03), urgent surgery (1.80, P = 0.05), an d advanced age (2.14, P= 0.01) were all predictors of operative mortal ity, In contrast, while choice of conduit appeared to influence outcom e by univariate analysis (4.2% mortality in group V, P < 0.001), it wa s not found to be a predictor of either mortality or morbidity by regr ession analysis. The present results indicate that, in carefully selec ted patients, despite increased technical demands with longer periods of aortic occlusion and longer pump times, multi-arterial grafting (co mpared with conventional revascularization) is a safe and efficacious procedure. Whether or not this approach to revascularization will incr ease long-term survival and freedom from reoperation will require furt her study. (C) 1998 The International Society for Cardiovascular Surge ry.