Faculty Collaboration Database

Measures to Increase Use of Multiple Arterial Grafts for Isolated Coronary Artery Bypass Grafting. J Am Coll Surg 2021 Jun;232(6):954-961

Date

02/27/2021

Pubmed ID

33636310

DOI

10.1016/j.jamcollsurg.2021.02.008

Scopus ID

2-s2.0-85102738847 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

BACKGROUND: Use of multiple arterial grafts (MAGs) provides superior patency and long-term survival benefit compared with venous grafts during coronary artery bypass grafting (CABG). However, MAGs are used infrequently for CABG. We hypothesized that specific measures introduced at our institution would lead to an increase in the use of MAGs.

STUDY DESIGN: Use of MAGs before and after introduction of bundled measures was compared. Measures included increased education in arterial graft harvesting, inclusion as a quality metric, and hiring of surgeon champions. Patients younger than 70 years who underwent first time, isolated CABG using at least 1 arterial graft were included. Number and type of grafts used were compared between time periods using chi-square test. Secondary outcomes included postoperative complications. Complications were compared between time periods, as well as between MAG and non-MAG recipients before and after propensity score matching using Fisher exact test and univariate logistic regression. Multivariable logistic regression was used to determine patient characteristics associated with MAG use.

RESULTS: There were 2,169 patients included from 2012 to 2019. MAG use increased significantly after introduction of measures (21.1% to 41.9%; p < 0.001). Radial artery use with an internal mammary artery (0.3% to 16%; p < 0.001) and the use of triple arterial grafts increased significantly (0% to 2.4%; p < 0.001). MAG use in the entire cohort was associated with decreased 30-day mortality and postoperative cardiac arrest that was not significant after propensity matching.

CONCLUSIONS: A programmatic emphasis on the use of MAGs for CABG is an effective method to increase its use.

Author List

Velez AK, Canner JK, Etchill E, Giuliano K, Alejo DE, Choi C, Kilic A, Schena S, Robert Whitman GJ, Lawton JS

Author

Stefano Schena MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Coronary Artery Bypass
Coronary Artery Disease
Female
Hospital Mortality
Humans
Male
Mammary Arteries
Middle Aged
Postoperative Complications
Propensity Score
Quality Improvement
Radial Artery
Retrospective Studies
Surgeons
Tissue and Organ Harvesting
Treatment Outcome
Vascular Patency