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Original Articles: Cardiovascular

Excellent Long-Term Clinical Outcome After Coronary Artery Bypass Surgery Using Three Pedicled Arterial Grafts in Patients With Three-Vessel Disease

^a Thoraxcenter, Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
^b Thoraxcenter, Department of Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands
^c Thoraxcenter, Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
^d Thoraxcenter, Department of Hematology, Division of Hemostasis, Thrombosis and Rheology, University Medical Center Groningen, University of Groningen, the Netherlands

Accepted for publication September 25, 2007.

^_* Address correspondence to Dr Boonstra, Thoraxcenter, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30,001, Groningen, 9700 RB, the Netherlands (Email: p.w.boonstra{at}thorax.umcg.nl).

Background: Long-term clinical outcome of complete arterial grafting in three-vessel disease is unknown.

Methods: We studied 344 patients who underwent complete arterial revascularization using the internal thoracic arteries and the right gastroepiploic artery. Freedom from major adverse cardiac events (MACE) was evaluated by the Kaplan-Meier method, and homogeneity of outcome in strata of patients was assessed using Cox proportional hazards modeling.

Results: Median follow-up of survivors was 9.3 years (range, 0.01 to 12.8 years). The 12-year freedom from MACE was 75.5%. For the composite of MACE, this was 86.9% for cardiovascular death, 93.3% for myocardial infarction, and 89.4% for reintervention. In patients aged older than 65 years, MACE occurred significantly more frequent, with a freedom from MACE of 65.8% compared with 82.6% in younger patients (hazard ratio, 3.4; 95% confidence interval, 2.1 to 5.6, p < 0.001).

Conclusions: Complete arterial revascularization using both pedicled internal thoracic arteries and the gastroepiploic artery in patients with three-vessel disease resulted in an excellent long-term clinical outcome, especially in patients aged younger than 65 years.

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