26 Coronary artery bypass grafting without an lad graft – is it worth it?

Objective Revascularisation of the left anterior descending (LAD) artery with a left internal mammary artery (LIMA) graft is often cited as the main benefit of surgery over stenting. Little is known about patients undergoing coronary artery bypass grafting (CABG) who do not receive a graft to their LAD. Methods We retrospectively reviewed our experience over a nine year period for patients undergoing coronary artery bypass grafting who did not receive a graft to the LAD. Patients undergoing any concomitant procedure aside from CABG were excluded. The National Death Registry was accessed for survival data. Results Full data was available on 91 patients, 14 of which had previous cardiac surgery. This represented 2% and 25% of our total CABG and redo CABG caseloads respectively. Mean logistic EuroSCORE was 5.9 and in-hospital mortality 3.2%, with O/E mortality 0.54. Reasons for lack of LAD graft and outcomes are shown below. Conclusion One in fifty patients undergoing isolated CABG do not receive a graft to their LAD artery. Although the peri-operative mortality is acceptable, the patient group with ungraftable LAD disease (82% of which had three vessel coronary disease) has a 5 year survival almost identical to those with complex disease randomised to PCI in the SYNTAX trial (80.8%). This suggests that depending each clinical situation, either treatment can be justified, but surgery does not seem to offer a prognostic benefit over stenting.