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?:abstract
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BACKGROUND Total arterial coronary revascularization for three vessel disease can be achieved with a second arterial conduit joined to the left internal mammary artery as a Y graft, using either a radial artery (RAY) or second mammary artery (BIMAY). METHODS Patients receiving total arterial revascularization for three coronary territory disease were identified from two cardiac surgical databases (Sydney and Melbourne) using Society of Thoracic Surgeons-based definitions. BIMAY patients underwent surgery between 1994 and 2009, mostly using an age-limited protocol, while RAY patients underwent surgery between 1996 and 2003 without age limits. All-cause mortality was acquired from the national death registry and survival estimated by the Kaplan-Meier method. Propensity score matching was performed using 13 variables. Due to the age imbalance between groups, the primary comparison was performed for age ≤66 years. RESULTS Overall, 1,896 patients received RAY and 720 patients received BIMAY. Older age at surgery was the strongest independent predictor for mortality with a hazard ratio of HR 2.06, 95%CI 1.93, 2.22, P<0.001. After propensity score matching, we identified 299 pairs of patients ≤66 years with no preoperative or operative differences and similar age at surgery, RAY 56.4±7.0 vs. BIMAY 56.4±6.8 years, P=0.96. The RAY group had 4.0±0.9 grafts and the BIMAY group had 3.9±0.9, P=0.814. All-cause mortality was not different, with the proportion surviving at 15 years at 74.9% for RAY vs. 76.2% for BIMAY (P=0.211). CONCLUSIONS Survival was not different between RAY and BIMAY for total arterial revascularization of three coronary territory bypass grafting.
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