Work

Long-Term Fate of Arterial or Venous Coronary Grafts to Chronic Total Occlusion Coronary Arteries

Year: 2026

Type: article

Abstract: BACKGROUND: It is unknown if internal mammary artery (IMA), radial artery (RA), or saphenous vein grafts (SVGs) supplying chronic total occlusion (CTO) coronary arteries exhibit increased failure over time compared with non-CTO targets. METHODS: Patients underwent predominantly symptom-indicated coronary angiography between 1997 and 2020 at the Royal Melbourne Hospital, after coronary artery bypass grafting. The primary outcome was the graft failure rate of IMA, RA, and SVGs with a CTO target compared with a non-CTO target, with failure additionally compared between conduits with a CTO target. Analysis was performed with an exchangeable generalised estimating equations multivariable binary logistic regression model. RESULTS: Overall, 313 patients had one or more CTO and 434 patients had only non-CTO targets, with follow-up at 8.7±5.6 years post-procedure. Grafts with CTO targets included 113 IMA, 240 RA, and 66 SVGs; grafts with non-CTO targets included 760 IMA, 940 RA, and 172 SVGs. IMA graft failure was less frequent with a CTO target than a non-CTO target; 0.9% vs 6.3% (odds ratio [OR] 0.14; 95% confidence interval [CI] 0.03-0.82; p=0.029). RA graft failure was also less frequent with a CTO target than a non-CTO target; 3.8% vs 14.4% (OR 0.19; 95% CI 0.09-0.40; p<0.001). In the case of SVGs, failure with a CTO vs non-CTO target was similar; 28.8% vs 19.8% (OR 1.06; 95% CI 0.30-3.76; p=0.932). Of grafts with a CTO target, failure was greater for SVGs than for arterial grafts; 28.8% vs 2.8% (OR 10.38; 95% CI 3.71-29.04; p<0.001), whereas failure was not different between IMA and RA grafts; 0.9% vs 3.8% (OR 0.45; 95% CI 0.10-2.02; p=0.297). CONCLUSION: Internal mammary and RA grafts had lower graft failure rates in the late term than SVGs when applied to CTO targets.

Source: Heart Lung and Circulation

DOI: 10.1016/j.hlc.2025.10.009

Authors: Christopher Siderakis, Nilesh Srivastav, Justin Ren, Colin Royse, Alistair Royse

Institutions: The University of Melbourne, The Royal Melbourne Hospital, RMIT University, National University of Malaysia

Language: English

Topic: Cardiac and Coronary Surgery Techniques

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,260