Abstract OBJECTIVES To evaluate whether the diagonal branch anastomotic angle (D-angle) influences outcomes following coronary artery bypass grafting (CABG). METHODS This study retrospectively examined 197 patients who underwent isolated CABG between 2010 and 2023 using left internal thoracic artery (LITA)–left anterior descending artery (LAD) grafting and clockwise right internal thoracic artery (RITA)–radial artery (RA) I-composite sequential grafts. Patients were categorised into Narrow (D-angle ≤ 90°, n = 16) and Wide (D-angle 90° or without diagonal anastomosis, n = 181) groups. RESULTS Mean age was 69 ± 10 and 65 ± 10 years in the Narrow and Wide groups, respectively (P = 0.107). Male sex (93.8% vs 91.2%), diabetes (68.8% vs 57.5%), three-vessel disease (75.0% vs 85.1%), and off-pump CABG (68.8% vs 76.2%) values were similar; however, the Narrow group had more anastomoses (4.2 ± 0.8 vs 3.4 ± 0.7, P 0.001). Median follow-up was 5.7 years 3.2–9.1. Rates of all-cause mortality and adverse cardiac events did not differ significantly (P = 0.193; P = 0.074). However, freedom from adverse sequential graft events was lower in the Narrow group, with 1-, 5-, and 10-year estimates of 74.0%, 74.0%, and 74.0%, compared with 93.6%, 92.0%, and 92.0% in the Wide group, respectively (log-rank P = 0.008). Narrow D-angle remained an independent predictor in multivariate analysis (adjusted hazard ratio, 4.3; 95% confidence interval, 1.3–13.7; P = 0.014). CONCLUSIONS A narrow D-angle was independently associated with increased incidence of adverse sequential graft events.
Ohtani et al. (Mon,) studied this question.