Multiple arterial grafting improves long-term survival over single arterial grafting: JAMA

A new study published in the Journal of American Medical Association showed that regardless of left ventricular failure, surgeons should emphasize multiple arterial grafting over single arterial grafting to increase long-term survival. Complete arterial revascularization, which removes saphenous vein grafts, is linked to the highest benefit.

When compared to single arterial grafting with additional saphenous vein grafts, multiarterial cardiac bypass surgeries have better clinical results. It is unclear, therefore, if multiarterial grafting offers a survival benefit for patients with different degrees of left ventricular dysfunction. Thus, to examine the long-term survival results of patients following multiple vs. single arterial grafts, stratified by preoperative ejection fraction, Justin Ren and team carried out this investigation.

Data from a multicenter population-based cardiac registry set up by the Australian & New Zealand Society of Cardiac & Thoracic Surgeons and linked to the National Death Index were used in complete-case retrospective cohort research. Those who had primary isolated coronary bypass surgery between June 1, 2001, and January 31, 2020, were considered participants.

Nonadults, reoperations, concurrent or prior heart surgery, single-graft surgeries, and instances lacking arterial grafts were also excluded. The patients were stratified by their preoperative left ventricular ejection fraction who received either single or multiple arterial grafts were included in the primary exposure. The main endpoint of the study was long-term all-cause mortality.

A total of 59,641 patients were included in the research (mean [SD] age at surgery: 65.8 [10.2] years; 48,321 men [81.0%]). 5.0 years was the median follow-up period (IQR: 2.3–8.6 years). Among patients with a normal left ventricular ejection fraction, multiarterial grafting was linked to a 19.0% relative decrease in all-cause mortality as compared to single artery transplantation.

The patients with mild, moderate, and severe left ventricular dysfunction showed comparable survival advantages. The multiarterial survival benefit by ejection fraction stratification did not differ significantly, according to a multivariable Cox proportional hazards regression interaction-term analysis. With the exception of cases where the left ventricular ejection fraction was less than 30%, multiarterial grafting using just arterial conduits was linked to greater survival advantages when compared to other multiarterial operations using saphenous vein grafts.

Overall, irrespective of the level of preoperative left ventricular ejection fraction (LVEF), multiple arterial grafting (MAG) in coronary artery bypass grafting (CABG) significantly decreased the risk of long-term all-cause mortality when compared with SAG, according to this retrospective cohort study that used a binational cardiac surgery database. When TAR was attained, the longevity benefit was highest, especially for patients with intact LVEF.

Source:

Ren, J., Bloom, J. E., Chan, W., Reid, C. M., Smith, J. A., Taylor, A., Kaye, D., Royse, C., Tian, D. H., Bowyer, A., El-Ansary, D., & Royse, A. (2025). Survival outcomes after multiple vs single arterial grafting among patients with reduced ejection fraction. JAMA Network Open, 8(4), e254508. https://doi.org/10.1001/jamanetworkopen.2025.4508