[Single versus multiple bypass grafts to each diseased coronary territory: impact on survival and major adverse cardiovascular and cerebrovascular events].

: Introducao: A revascularizacao completa representa o gold standard para a cirurgia de revascularizacao miocardica. No entanto, a pontagem de todas as arterias com doenca significativa no mesmo territorio coronario e controversa. Deste modo, objetivamos avaliar o impacto, na sobrevivencia a longo e na incidencia de eventos cardio e cerebrovascular major (MACCE), da colocacao de um enxerto unico versus multiplos enxertos coronarios no mesmo territorio. Metodos: de Janeiro/00 a Novembro15, 5.694 doentes foram consecutivamente submetidos a CABG isolada, dos quais 4.243 (74.5%) tiveram revascularizacao anatomica completa, constituindo a populacao em estudo. Os doentes foram dividos em dois grupos: os que receberam enxertos multiplos para cada territorio (CD, DA, CX, n=755) e os que receberam um enxerto unico (n=3.488). O tempo medio de seguimento foi de 8.5±4.4 anos e completo em 96.4% dos doentes. Resultados: nao foram observadas diferencas no que respeita as complicacoes major pos-operatorias (choque cardiogenico, enfarte agudo do miocardio ou acidente vascular cerebral) bem como na mortalidade aos 30 dias (0.7%; p=0.871). A sobrevivencia a longo prazo foi 64.4±1.3% vs. 67.7±2.9%, p=0.232. A idade avancada (HR:1.07; 1.06-1.08, p<0.001), diabetes (HR:1.44; 1.24-1-66, p<0.001), doenca vascular periferica (HR:1.52; 1.29-1.81, p< 0.001), doenca pulmonar cronica obstrutiva (HR:1.38; 1.01-1.89, p=0.042), disfuncao cardiaca moderada/severa (HR:1.95; 1.60-2.38, p< 0.001) e disfuncao renal moderada/severa (HR:1.65; 1.40-1.94, p< 0.001) foram preditores de mortalidade a longo prazo. A taxa livre de MACCE foi superior no grupo com multiplos enxertos aos 4 anos (79.4±2.0% vs. 90.7±2.7%; p=0.026, respetivamente). Conclusao: a CABG e realizada com seguranca e com baixa mortalidade. O numero de enxertos nao afetou os resultados perioperatorios e a sobrevivencia a longo prazo. No entanto, a confeccao de multiplos enxertos foi associada a menor incidencia de MACCE. METHODS: From January/00 to November/15, 5.694 consecutive patients were submitted to isolated CABG, of whom 4.243 (74.5%) had complete anatomical revascularization and constituted the study population. Patients were divided into two groups: multiple grafts to each major territory (RCA, LAD, Cx, n=755) a single graft to each territory (n=3.488). Mean follow-up time was 8.5±4.4 years and complete for 96.4% of patients. RESULTS: No differences were found concerning major immediate postoperative complications (cardiogenic shock, acute myocardial infarction or stroke) and thirty-day mortality was similar (0.7%; p=0.871). Long-term survival was 64.4±1.3% vs. 67.7±2.9%, p=0.232. Older age (HR:1.07; 1.06-1.08, p<0.001), diabetes mellitus (HR:1.44; 1.24-1-66, p<0.001), peripheral vascular disease (HR: 1.52; 1.29-1.81, p<0.001), chronic obstructive pulmonary disease (HR:1.38; 1.01-1.89, p=0.042), moderate/ severe cardiac dysfunction (HR:1.95; 1.60-2.38, p<0.001) and moderate/severe renal impairment (HR:1.65; 1.40-1.94, p<0.001) were independent predictors for late mortality. Freedom from MACCE was higher in multiple graft group (79.4±2.0% vs. 90.7±2.7%; p=0.026, respectively) at 4 years. CONCLUSION: Isolated CABG can be performed safely and with very low mortality. The number of bypass grafts did not adversely affect the perioperative results and long-term survival. However, implantation of multiple grafts was associated with lower incidence of major adverse events.