SPC365

Long-Term Outcomes of Delayed Percutaneous Intervention versus Saphenous Vein Graft for Revascularizing the Right Coronary Artery

Session: Sessão de Posters 25 - Cirurgia cardíaca
Speaker: Inês Sousa

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 26. Cardiovascular Surgery
Subtheme: 26.11 Cardiovascular Surgery - Other
Session Type: Cartazes
FP Number: ---
Authors: Inês Sousa; Rui Cerqueira; Mário J. Amorim; Sílvia O. Diaz; Ana Filipa Ferreira; Paulo Pinho; André P. Lourenço; António S. Barros; Francisca Saraiva; Adelino Leite-Moreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> - The optimal strategy to revascularize the right coronary artery(RCA) can vary depending on the patient&#39;s clinical condition and the extent of coronary artery disease. Different perspectives have been raised in the literature regarding the best approach to revascularize the RCA. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Aim</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> &ndash; To compare long-term survival, need for redo CABG and postoperative outcomes among 3 alternatives for RCA revascularization:</span></span><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> saphenous vein graft(SVG) anastomosed to the ascending aorta[SVAo]; right internal mammary artery prolongation with SVG-aortic no-touch technique[SVrima]; and post-operative percutaneous intervention - Hybrid approach[PCI].</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> - Longitudinal, retrospective, single-center cohort including consecutive patients that underwent primary isolated multivessel (&ge;2 vessels disease, with indication for RCA revascularization) off-pump CABG(2009-2014). Emergent/salvage surgeries were excluded. The primary outcome was all-causes mortality(February 2023). Time-to-event outcomes were represented using Kaplan-Meier Curves, Log-Rank test and multivariable Cox Regression (SVAo as the reference). Median follow-up was 10 years, maximum of 14 years.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> &ndash; We included 412 patients (81% male), 65%SVAo, 12%PCI and 23%SVrima. PCI&rsquo;s group had older patients (mean age PCI 65&plusmn;10 years,SVAo 64&plusmn;10 years,SVrima 61&plusmn;10 years,p=0.02). The prevalence of cardiovascular risk factors was well balanced between groups (arterial hypertension-p=0.88; dyslipidemia-p=0.65; diabetes <em>mellitus-</em>p=0.33, obesity-p=0.77). Coronary artery disease was similar between groups (Canadian Coronary Society-grade IV, p=0.55 and recent myocardial infarction, p=0.20). Concerning intervention characteristics, complete revascularization was higher in SVrima group than in SVAo and PCI (97%,80% and 82% respectively, p&lt;0.001). Univariable survival analysis reported no differences between groups (Log-Rank test p=0.68). At 5- and 10- years of follow-up, cumulative survival for SVAo vs PCI vs SVrima were 91%vs84%vs90% and 72%vs66%vs69%, respectively. Multivariable adjustment showed that the RCA approach did not impact on long-term survival (HR[95%CI]:1.41[0.75-2.65],p=0.30 and HR:1.20[0.64-2.26],p=0.60). Most of post-operative outcomes were similar between groups including hospital mortality, except for time to discharge that was higher in PCI patients (median time [min-max] PCI:8.00[5-29] days; SVrima:6[5-64]; SVAo:6[4-142], p&lt;0.001). Reoperation for redo-bypass was not performed in any of the patients.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: The approach for RCA revascularization did not seem to be associated with all-causes of death and hospital mortality after 14 years of follow-up. However, for establishing an optimal approach is necessary to also explore data from other events, including need for percutaneous re-revascularization and graft&nbsp;patency.</span></span></span></span></p>