Poll Results: Strategy For Conduit Choice During Coronary Artery Bypass Grafting

Jul 26, 2022   |  Karen M Kim, MD

Poll

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This poll asked readers to weigh the patient's early age and low surgical risk against co-morbidities of poorly controlled diabetes mellitus and morbid obesity when considering conduit choice for coronary artery bypass grafting (CABG).

Thirty-nine percent of readers chose CABG with single internal mammary artery (SIMA) while the rest would pursue a strategy of at least bilateral internal mammary artery (BIMA) for multiple- (22% of readers) or total- (40% of readers) arterial grafting.

Poll Results: Strategy For Conduit Choice During Coronary Artery Bypass Grafting

The prevalence of multiple arterial grafting as reported in various North American and European registries ranges from 4% to 28%.1 In The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD), among patients 50 years or younger who underwent isolated multi-vessel CABG from 2008-2018, 14.1% received multiple arterial grafting, among which a strategy of BIMA was utilized in 66.1%.2

While poorly controlled diabetes did not impact short-term mortality between patients undergoing CABG with SIMA versus BIMA in a large propensity matched study using the STS ACSD, the incidence of sternal wound infection was significantly higher for CABG with BIMA compared to SIMA at hemoglobin A1c levels of 7% or higher.3

Regarding conduit choice, several multi-society guidelines consider a second arterial graft reasonable in appropriate patients and anatomy, with excessive risk of sternal complications a possible deterrent to BIMA use.

References

  1. Gaudino M, Chikwe J, Falk V, Lawton JS, Puskas JD, Taggart DP. Transatlantic editorial: the use of multiple arterial grafts for coronary revascularization in Europe and North America. Eur J Cardiothorac Surg 2020;57:1032-37.
  2. Gaudino M, Rahouma M, Habib RH, et al. Surgeons' coronary bypass practice patterns in the United States. J Am Coll Cardiol 2020;76:1714-15.
  3. Kazui T, Lick SD, Hsu C-H, Bull DA. Short-term risk of bilateral internal mammary artery grafting in diabetic patients. Semin Thoracic Cardiovasc Surg 2021;33:382-92.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention

Keywords: Mammary Arteries, Glycated Hemoglobin A, Incidence, Obesity, Morbid, Prevalence, Coronary Artery Bypass, Diabetes Mellitus, Wound Infection, Registries, Surgeons


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