Arterial Revascularization Superior in Bypass Surgery

A new study concludes that diabetic patients who undergo coronary artery bypass surgery (CABG) have better long-term outcomes when arteries are used rather than veins.

Researchers at Royal Melbourne Hospital (RMH; Australia) and the University of Melbourne (Australia) reviewed 63,592 cases from the Australian and New Zealand Society of Cardiothoracic Surgeons (ANZSCTS) database, identifying 34,181 patients (34.1% diabetics), who underwent isolated CABG between 2001and 2012; total arterial revascularization (TAR) was performed in 35.9% of the patients. The researchers then matched 6,232 diabetic and non-diabetic pairs.

The results showed that more diabetic patients survive when only arteries are used for bypasses during CABG surgery. Diabetic patients also experience fewer long-term complications from TAR/CABG than from conventional CABG. The researchers also found that TAR/CABG can be performed on diabetic patients without increasing the rate of complications, such as angina (chest pain), heart attacks, heart failure, and hospital readmissions. The study was published on July 14, 2016, in The Annals of Thoracic Surgery.

“Average conventional CABG surgery involves three to four grafts: one artery is usually used, along with vein grafts from the leg or thigh for the remaining new bypasses. In TAR/CABG surgery, only arteries are used,” said lead author James Tatoulis, MD, of RMH and the University of Melbourne. “For every 100 diabetic patients undergoing CABG surgery, four more will be alive at 10 years when arteries are used for the bypasses, rather than just one arterial graft together with veins.”

For patients with coronary artery disease (CAD), a coronary artery surgical bypass can be placed to reroute blood around blocked arteries to restore and improve blood flow and oxygen to the heart. To create the bypass graft, a surgeon harvests healthy blood vessels from another part of the body, often from the patient's leg or arm. This vessel becomes a graft, with one end attaching to a blood source above and the other end below the blocked area, creating a new conduit channel.

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