A Comparative Analysis of CABG Outcomes in Women Using Different Conduits In The National UK Dataset.

Overview

BACKGROUND: There is limited report of outcomes in women undergoing isolated coronary artery bypass grafting (CABG) with left internal thoracic artery and different second conduits (saphenous vein grafts [SVGs], radial artery [RA], and right internal thoracic artery [RITA]). METHODS: The National Adult Cardiac Surgery database was queried for women undergoing isolated CABG with left internal thoracic artery graft in the UK from 1996 to 2019. Propensity score-based pairwise comparisons were performed between graft types. The primary outcome was in-hospital mortality. RESULTS: 58,063 women were included (SVG n=48,881, 84.2%; RA n=6,136, 10.6%; n=2,445, 4.2%). SVG use was stable over the years, RA and RITA use decreased. In-hospital mortality was similar between the RA and the RITA grafts (2.3% vs 2.8%; OR 0.80, 95%CI 0.53-1.22;P=0.31) and between the RA and SVG (2.3% vs 2.0%; OR 1.20, 95%CI 0.93-1.55;P=0.17) but was higher in the RITA group compared to the SVG (2.7% vs 1.4%; OR 2.04, 95%CI 1.27-3.36;P=0.004). Women receiving the RITA graft were more likely to develop sternal wound infection (SWI) compared to the RA (0.6% vs 0.06%;P=0.004) and the SVG (0.6% vs 0.2%;P=0.032). SWI was consistently associated with higher risk of in-hospital mortality. CONCLUSIONS: Conduit selection may affect operative outcomes in women undergoing CABG. The RA shows similar mortality and risk of DSWI as the SVG.