Early Outcomes of Two Strategies of Sequential Grafting of in Situ Skeletonized Left Internal Mammary Artery to the Left Coronary System

Background: To evaluate early outcomes of two strategies of sequential grafting of in situ skeletonized left internal mammary artery (LIMA) to the left coronary system in a single-center study.
Methods: A total of 1712 patients receiving first, scheduled, isolated coronary artery bypass grafting (CABG) with in situ skeletonized LIMA grafting to the left coronary system were included and were devided into three group: a DOM group (sequential grafting of LIMA to the diagonal and then to the obtuse marginal artery, n=115), a DLAD group (sequential grafting of LIMA to the diagonal and then to the left anterior descending artery (LAD), n=123), and a control group (separate grafting of LIMA to the LAD, n=1474). The in-hospital and follow-up clinical outcomes, and follow-up LIMA graft patency were investigated and compared.
Results: No significant differences were found in the in-hospital outcomes and follow-up all-cause mortality, and the incidence of follow-up repeat revascularization between the DOM group and the control group, between the DLAD group and the control group, and between the DOM group and the DLAD group. After adjustment for potential confounders, sequential LIMA grafting was not found to be an independent predictor of adverse events, and the two strategies of sequential LIMA grafting received similar incidences of adverse events. During a follow-up period of more than 27 months, 100% patency rate for the LAD site and 97.3% for the obtuse marginal site in the DOM group, and 99.1% for the diagonal site and 98.3% for the LAD site in the DLAD group, all of which were similar with the patency rate of separate grafting of LIMA to the LAD.
Conclusions: The two strategies of sequential grafting of in situ skeletonized LIMA to the left coronary system resulted in excellent clinical outcomes and graft patency.