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.