Study design
This observational, retrospective study was designed according to STROBE
guidelines(Strengthening The Reporting of Observational Studies in
Epidemiology)13. Between January-2006 and June-2018,
9602-patients underwent isolated CABG at two cardiac surgery
centers(Medinet Heart Center Ltd in Nowa Sol and Wroclaw, Poland). We
retrospectively analyzed prospectively collected data from the surgical
database in both centers. The data are collected and reported in
accordance with Polish National Registry of Cardiac Surgery Procedures
database which is mandatory for every cardiac surgery department in
Poland. The database captures detailed information on preoperative,
intraoperative, and hospital postoperative variables for all patients
undergoing any cardiac surgery procedure.
Patients included in the final analysis met the following criteria:
first-time isolated CABG with multivessel disease requiring at least two
coronary grafts; LITA used in situ to graft LAD territory and additional
saphenous vein graft(SVG) for non-LAD target(SITA+Vein group) or one of
the ITA’s used in-situ to graft LAD territory and additional second ITA
in-situ or as composite graft for non-LAD target or the use of RA as
second graft for the non-LAD target(2nd-arterial
conduit group). Patients with additional SVG in the
2nd arterial conduit group were also included. ITA’s
were harvested as pedicled or skeletonized graft, whereas RA was
harvested as pedicled graft. RITA was used in cases where target
stenosis was(>70%) or in isolated Left main
disease(>50%). RITA was used as an in-situ graft or as a
composite graft proximally connected to LITA. The RA was used in cases
where target stenosis was(>70%) in the left coronary
system or(>80%) in the right coronary system. RA was used
as a free graft directly connected to the ascending aorta. Overall,
7857-patients met the inclusion criteria and were divided into two
groups: SITA+Vein group(n=7140) and 2nd-arterial
conduit group(n=717), of these 537-patients received RITA and
180-patients received RA. Figure.1 represents patients flow chart
diagram. The study was approved by the Institutional Review Board at
Medinet Heart Center. An individual consent of the patients for
anonymous data analysis was waived by the Committee.