Key result
In-situ LIMA with SVG composite grafting for LAD revascularization yielded comparable mid-term MACCE rates (14.2% vs 12.3%, HR 1.18) and early mortality compared to LIMA alone.
Why the study?
The study aimed to evaluate early and mid-term outcomes of using in-situ LIMA with a great saphenous vein graft to bypass the LAD in CABG.
Does an in-situ LIMA with SVG composite graft provide comparable early and mid-term outcomes to LIMA alone for LAD revascularization in patients undergoing CABG?
Observational (n=310)
No
Does an in-situ LIMA with SVG composite graft provide comparable early and mid-term outcomes to LIMA alone for LAD revascularization in patients undergoing CABG?
Hazard Ratio: 1.18 (95% CI 0.38–6.72)
Absolute Event Rate: 14.2% vs 12.3%
p-value: p=0.73
A composite LIMA and SVG graft offers a viable, comparable alternative to LIMA alone for LAD revascularization during CABG when LIMA length is inadequate.
Hypothesis-generating for LIMA+SVG composite grafting in CABG; leaves open need for RCTs before clinical adoption.
Aim. This study aimed to evaluate the early and mid-term outcomes of a novel strategy using the in-situ left internal mammary artery (LIMA) with a great saphenous vein graft (SVG) to bypass the left anterior descending artery (LAD) in coronary artery bypass grafting (CABG). Materials and methods. A total of 1,240 patients were included in this retrospective observational study. Using propensity-score matching, 155 patients were assigned to the LIMA + SVG group and 155 to the LIMA − LAD group. Early mortality, postoperative complications, and mid-term major adverse cardiovascular and cerebrovascular events (MACCE) were compared between the two matched groups following the procedure. Results. No significant differences were observed in early mortality rates between the LIMA + SVG group and the LIMA − LAD group (3.2 % vs. 2.6 %, P=0.69). For mid-term outcomes, the incidence of MACCE was slightly higher in the LIMA + SVG group, but this difference was not statistically significant (14.2 % vs. 12.3 %, hazard ratio = 1.18, 95% CI, 0.38 to 6.72; P=0.73). Computed tomography coronary artery angiography (CTCA) revealed a LIMA + SVG composite graft patency rate of 93 % (72/77) at 25 months post-procedure. Conclusions. The use of in-situ LIMA with SVG to revascularize LAD was associated with comparable early and mid-term outcomes to using LIMA alone. These findings suggest that the LIMA + SVG composite graft may be a viable alternative strategy when LIMA alone cannot adequately bypass the LAD, particularly in emergency settings.
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Solanki et al. (2025) conducted an observational in Coronary artery disease requiring left anterior descending artery revascularization (n=310). In-situ left internal mammary artery (LIMA) with a great saphenous vein graft (SVG) composite graft vs. LIMA directly to LAD (LIMA-LAD) was evaluated on Mid-term major adverse cardiovascular and cerebrovascular events (MACCE) (HR 1.18, 95% CI 0.38 to 6.72, p=0.73). In-situ LIMA with SVG composite grafting for LAD revascularization yielded comparable mid-term MACCE rates (14.2% vs 12.3%, HR 1.18) and early mortality compared to LIMA alone.
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