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Abstract：
Background It is unknown if the presence of saphenous vein grafting (SVG) adversely affects late survival following coronary surgery with multiple arterial grafting (MAG) versus single arterial grafting. Methods and Results A retrospective, observational, multicenter cohort study from 2001 to 2020 was conducted using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database linked to the National Death Index. Patients undergoing primary isolated coronary artery bypass grafting with ≥2 grafts were included, and exclusions were patients aged <18 years, reoperations, concomitant or previous cardiac surgery, and the absence of arterial grafting. Demographics, comorbidities, medication, and operative configurations were propensity score matched between cohorts. The primary outcome was all-cause late death. Of 59 689 eligible patients, 35 113 were MAG (58.8%), and 24 576 were single arterial grafting (41.2%). Of the MAG cohort, 17 055 (48.6%) patients did not receive supplementary SVG (total arterial revascularization). Matching separately generated 22 764 patient pairs for MAG versus single arterial grafting, and 11 137 patient pairs for MAG with total arterial revascularization versus MAG with ≥1 supplementary vein grafts. At a median follow-up duration of 5.0 years postoperatively, the mortality rate was significantly lower for MAG than single arterial grafting (hazard ratio [HR], 0.79 [95% CI, 0.76-0.83]; P<0.001). The stratified MAG analysis found that MAG with total arterial revascularization had a lower risk of late death (HR, 0.85 [95% CI, 0.80-0.91]; P<0.001) compared with MAG with ≥1 supplementary vein grafts. Sensitivity analyses produced consistent outcomes as the primary analysis. Following adjustment for the presence of SVG in the Cox model, the survival advantage of incremental number of arteries was lost. Conclusions Multiple arterial grafting has significantly improved long-term survival compared with single arterial grafting. A further incremental survival benefit exists when no SVG is used.
摘要：
背景与单动脉移植相比，隐静脉移植（SVG）的存在是否会对冠状动脉手术后的晚期生存率产生不利影响尚不清楚。方法和结果回顾性分析，观察,2001年至2020年的多中心队列研究使用与国家死亡指数相关的澳大利亚和新西兰心脏和胸外科医师协会数据库进行。包括进行初次孤立冠状动脉旁路移植术的患者，其中移植物≥2，和排除的患者年龄<18岁，重新操作,伴随或先前的心脏手术，没有动脉移植.人口统计,合并症,药物,和手术配置是队列之间的倾向评分匹配。主要结果是全因晚期死亡。在59689名合格患者中，MAG为35113（58.8%），单动脉移植24576例(41.2%)。在MAG队列中，17055例（48.6％）患者未接受补充SVG（全动脉血运重建）。分别匹配MAG与单动脉移植的22764例患者对，11137例MAG合并全动脉血运重建与MAG合并≥1例补充静脉移植。术后中位随访时间为5.0年，MAG的死亡率明显低于单动脉移植(风险比[HR]，0.79[95%CI，0.76-0.83]；P<0.001）。分层MAG分析发现，MAG合并全动脉血运重建的晚期死亡风险较低（HR，0.85[95％CI，0.80-0.91]；P<0.001）与具有≥1个补充静脉移植物的MAG相比。敏感性分析产生了一致的结果作为主要分析。在Cox模型中调整SVG的存在之后，动脉数量增加的生存优势丧失。结论与单动脉移植相比，多动脉移植能显著提高远期生存率。当不使用SVG时,存在进一步增加的生存益处。
