OBJECTIVES: Relative rates of early graft failure and conduit selection in coronary artery bypass grafting (CABG) surgery remain controversial. Therefore, we sought to determine the incidence and determinants of graft failure of the left internal mammary artery (LIMA), radial artery, saphenous vein, and right internal mammary artery (RIMA) 1 year after CABG surgery. METHODS: A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) CABG study, involving patients from 83 centers in 22 countries. We completed an analysis of 3480 grafts from 1068 patients who underwent CABG surgery with complete computed tomography angiography data. The primary outcome was graft failure as diagnosed by computed tomography angiography 1 year after surgery. RESULTS: Graft failure occurred in 6.4% (68/1068) for LIMA, 9.9% (9/91) for radial artery, 10.4% (232/2239) for saphenous vein, and 26.8% (22/82) for RIMA grafts. The RIMA had a greater rate of graft failure (26.8%) than radial artery (9.9%) and veins (10.4%) (adjusted odds ratio, 2.69; 95% confidence interval, 1.30-5.57; P = .008 and adjusted odds ratio, 2.07; 95% confidence interval, 1.33-3.21; P = .001, respectively). CONCLUSIONS: In this international trial dataset, LIMA and radial artery performed as expected, whereas vein grafts performed better. However, high rates of RIMA failure are worrisome and highlight the need for a thorough evaluation of the patency and safety of the RIMA in CABG surgery.

Department of Cardiac Surgery Centre Hospitalier de l'Universite de Montreal Montreal Quebec Canada

Department of Cardiac Surgery Fakultní nemocnice Hradec Králové Hradec Králové Královéhradecký Czech Republic

Department of Cardiac Surgery Quebec Heart and Lung Institute affiliated with Laval University Quebec City Quebec Canada

Department of Cardiovascular Surgery Fuwai Hospital Beijing China

Department of Medicine McMaster University Hamilton Ontario Canada

Department of Perioperative Medicine Population Health Research Institute Hamilton Ontario Canada

Department of Research Hamilton Health Sciences Hamilton Ontario Canada

Department of Statistics Population Health Research Institute Hamilton Ontario Canada

Department of Surgery McMaster University Hamilton Ontario Canada

Department of Surgery McMaster University Hamilton Ontario Canada; Department of Perioperative Medicine Population Health Research Institute Hamilton Ontario Canada

J Thorac Cardiovasc Surg. 2023 Mar;165(3):1090-1091. doi: 10.1016/j.jtcvs.2022.06.007. PubMed

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ClinicalTrials.gov
NCT01776424