Multiple arterial grafts does not increase perioperative or short- to medium-term risks of postoperative MACE in patients with impaired left ventricular function: 3-year follow-up results

doi:10.12122/j.issn.1673-4254.2025.02.04

Abstract

Abstract:

Objective To compare perioperative and mid-term results of multiple versus single arterial off-pump coronary artery bypass grafting (OPCABG) in patients with impaired left ventricular function. Methods This study was conducted among 86 patients with a left ventricular ejection fraction (LVEF) <50%, who underwent OPCABG at our hospital between January, 2018 and December, 2021. Of these patients, 22 underwent OPCABG with multiple arterial grafts (multiple graft group) and 64 received a single arterial graft in OPCABG (single graft group). The preoperative, intraoperative, and perioperative data were collected, and the patients were followed up for a mean of 29.28±14.84 months. The perioperative outcomes and follow-up results of the patients were compared, and the factors influencing major adverse cardiovascular events (MACE) were identified using logistic regression. Kaplan-Meier analysis was used to compare the postoperative survival rate without MACE. Results The patients in multiple graft group had a significantly younger age than those in single graft group (P<0.05), but the other baseline data were similar between the two groups (P>0.05). Perioperative mortality, 24-h postoperative drainage volume, length of ICU stay, intubation time, and the incidence of new-onset atrial fibrillation were all similar between the two groups (P>0.05), but the rate of postoperative hypotension was significantly higher in multiple graft group (34.78% vs 11.54%, P=0.009). No significant differences were found in the incidence of MACE or echocardiographic data during the follow-up. Logistic regression identified the female sex (OR: 0.191, 95% CI: 0.049-0.075) and creatinine level (OR: 1.016, 95% CI: 1.000-1.033) as factors affecting postoperative MACE occurrence. Kaplan-Meier analysis showed no significant difference in MACE-free survival rate between the two groups. Conclusion OPCABG with multiple arterial grafts does not increase severe perioperative complications or the risk of mid-term MACE in patients with impaired left ventricular function.

Key words: coronary artery bypass grafting, off-pump, multiple arterial graft, reduced left ventricular function

Ziru LI, Shengwei BAI, Jian ZHANG, Hao XU, Suhua ZANG, Xin ZHANG. Multiple arterial grafts does not increase perioperative or short- to medium-term risks of postoperative MACE in patients with impaired left ventricular function: 3-year follow-up results[J]. Journal of Southern Medical University, 2025, 45(2): 239-244.

Figures/Tables 5

References 30

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Variable	Multiple arterial group (n=22)	Single arterial group (n=64)	t/Z/χ²	P
Gender [n (%)]
Male	20 (90.91)	49 (76.56)	2.411	0.121
Female	2 (9.09)	15 (23.44)	2.411	0.121
Age (year)	54.05±6.31	61.41±7.83	-3.982	<0.001
Hypertension [n (%)]	9 (40.91)	28 (43.75)	0.054	0.816
Stroke [n (%)]	2 (9.09)	5 (7.81)	0.035	0.852
Diabetes [n (%)]	7 (31.82)	25 (39.06)	0.368	0.544
PCI [n (%)]	3 (13.64)	8 (12.50)	0.019	0.891
AST (U/L)	20.00 (17.00, 28.75)	22.00 (16.00, 38.75)	-0.228	0.820
SCr (μmol/L)	80.50 (69.00, 101.50)	74.00 (63.50, 88.50)	-1.802	0.072
Albumin (g/L)	42.40 (39.05, 44.65)	40.55 (37.80, 43.45)	-1.599	0.110
LVEF (%)	47.50 (36.75, 51.25)	47.00 (40.00, 51.00)	-0.149	0.882
LVEDD (mm)	54.23±6.48	55.95±7.13	-1.001	0.320
LVESV (mL)	91.00 (62.00, 118.50)	93.00 (72.00, 121.00)	-0.597	0.550
PASP (mmHg)	21.00 (20.00, 23.00)	22.50 (21.00, 29.75	-1.844	0.065
AST: Aspartate transaminase; SCr: Serum creatinine; LVEF: Left ventricular ejection fraction; LVEDD: Left ventricular end-diastolic diameter; LVESV: Left ventricular end-systolic volume; PASP: pulmonary artery systolic pressure.

Variable	Multiple arterial group (n=22)	Single arterial group (n=64)	t/Z/χ²	P
Gender [n (%)]
Male	20 (90.91)	49 (76.56)	2.411	0.121
Female	2 (9.09)	15 (23.44)	2.411	0.121
Age (year)	54.05±6.31	61.41±7.83	-3.982	<0.001
Hypertension [n (%)]	9 (40.91)	28 (43.75)	0.054	0.816
Stroke [n (%)]	2 (9.09)	5 (7.81)	0.035	0.852
Diabetes [n (%)]	7 (31.82)	25 (39.06)	0.368	0.544
PCI [n (%)]	3 (13.64)	8 (12.50)	0.019	0.891
AST (U/L)	20.00 (17.00, 28.75)	22.00 (16.00, 38.75)	-0.228	0.820
SCr (μmol/L)	80.50 (69.00, 101.50)	74.00 (63.50, 88.50)	-1.802	0.072
Albumin (g/L)	42.40 (39.05, 44.65)	40.55 (37.80, 43.45)	-1.599	0.110
LVEF (%)	47.50 (36.75, 51.25)	47.00 (40.00, 51.00)	-0.149	0.882
LVEDD (mm)	54.23±6.48	55.95±7.13	-1.001	0.320
LVESV (mL)	91.00 (62.00, 118.50)	93.00 (72.00, 121.00)	-0.597	0.550
PASP (mmHg)	21.00 (20.00, 23.00)	22.50 (21.00, 29.75	-1.844	0.065
AST: Aspartate transaminase; SCr: Serum creatinine; LVEF: Left ventricular ejection fraction; LVEDD: Left ventricular end-diastolic diameter; LVESV: Left ventricular end-systolic volume; PASP: pulmonary artery systolic pressure.

Variable	Multiple arterial group (n=22)	Single arterial group (n=64)	t/Z/χ²	P
Number of grafts	3.73±0.94	3.69±0.71	0.208	0.835
Heparin-protamine time (h)	173.85±40.82	152.47±43.57	1.937	0.056
24-hour postoperative drainage volume (mL)	675.68±258.96	643.88±270.17	0.481	0.632
Reoperation [n (%)]	1 (4.55)	1 (1.56)	0.634	0.426
Postoperative dialysis [n (%)]	0 (0.00)	1 (1.56)	0.344	0.558
In-hospital mortality[n (%)]	1 (4.55)	1 (1.56)	0.634	0.426
Postoperative intubation time (h)	20.90 (16.45, 26.20)	20.80 (16.20, 22.00)	-0.678	0.498
ICU length of stay (h)	60.85 (36.65, 67.63)	60.25 (41.00, 67.88)	-0.361	0.718
Postoperative hypotension [n (%)]	8 (36.36)	9 (12.50)	5.568	0.018
New-onset Atrial Fibrillation [n (%)]	1 (4.55)	10 (15.63)	2.160	0.142
Postoperative in-hospital time (d)	10.00 (8.00, 14.00)	11.00 (9.00, 15.00)	-1.311	0.190
LVEF (%)	50.32±8.94	48.81±7.44	0.777	0.440
LVEDD (mm)	49.82±5.59	51.73±6.43	-1.239	0.219
LVESV (mL)	68.55±30.13	73.68±41.18	-0.536	0.593
PASP (mmHg)	23.00 (21.00, 28.50)	21.00 (21.00, 28.75)	-0.032	0.975

Variable	Multiple arterial group (n=22)	Single arterial group (n=64)	t/Z/χ²	P
Number of grafts	3.73±0.94	3.69±0.71	0.208	0.835
Heparin-protamine time (h)	173.85±40.82	152.47±43.57	1.937	0.056
24-hour postoperative drainage volume (mL)	675.68±258.96	643.88±270.17	0.481	0.632
Reoperation [n (%)]	1 (4.55)	1 (1.56)	0.634	0.426
Postoperative dialysis [n (%)]	0 (0.00)	1 (1.56)	0.344	0.558
In-hospital mortality[n (%)]	1 (4.55)	1 (1.56)	0.634	0.426
Postoperative intubation time (h)	20.90 (16.45, 26.20)	20.80 (16.20, 22.00)	-0.678	0.498
ICU length of stay (h)	60.85 (36.65, 67.63)	60.25 (41.00, 67.88)	-0.361	0.718
Postoperative hypotension [n (%)]	8 (36.36)	9 (12.50)	5.568	0.018
New-onset Atrial Fibrillation [n (%)]	1 (4.55)	10 (15.63)	2.160	0.142
Postoperative in-hospital time (d)	10.00 (8.00, 14.00)	11.00 (9.00, 15.00)	-1.311	0.190
LVEF (%)	50.32±8.94	48.81±7.44	0.777	0.440
LVEDD (mm)	49.82±5.59	51.73±6.43	-1.239	0.219
LVESV (mL)	68.55±30.13	73.68±41.18	-0.536	0.593
PASP (mmHg)	23.00 (21.00, 28.50)	21.00 (21.00, 28.75)	-0.032	0.975

Variable	Multiple arterial group (n=22)	Single arterial group (n=64)	χ²	P
MACE	4(18.18)	14(21.88)	0.138	0.710
Cardiac death	0(0.00)	2(3.13)	1.198	0.274
Recurrent angina	3(13.64)	7(10.94)	0.113	0.737
Recurrent myocardial infarction	0(0.00)	2(3.13)	1.198	0.274
Revascularization therapy	0(0.00)	1(1.56)	0.595	0.441
Heart failure readmission	3(13.64)	9(14.06)	0.002	0.960
MACE: Major adverse cardiovascular events.