No-touch aorta off-pump LIMA-radial Y-graft CABG: A safe strategy for all-comers: Long term follow up of a preferred treatment approach

Objectives:
Survival of no-touch aorta, total arterial off-pump CABG (OPCAB) with LIMA - radial artery Y-graft in 2004 - 2021 for all-comers for isolated CABG regardless of preoperative factors.
Patients and methods:
All patients with OPCAB no-touch aorta total arterial LIMA- RA Y-graft surgeries performed between 2004 and 2021 without any concomitant interventions were included. OPCAB was performed by a team of experienced surgeons. For 5 year survival times, Kaplan-Meier test and Cox regression were used. Patients were categorised into 5 age groups (<50 y.o.;50-59;60-69; 70-79; >80 years).
Results:
2174 patients were included. Median follow-up time was 3266 days. Mean number of grafts was 3,7 with little variation between age groups ranging from 3.6 to 3.8 (p=0.09), respectively. The 5 year survival probability was 90% (n=1767) and ranged between age groups from 98% to 65% (log rank: p=<0.0001). A Cox regression model observed that sex, age, NYHA class>1, CCS class IV, left ventricular ejection fraction, previous stroke, diabetes, PAD, chronic lung disease, EuroSCORE I (log) were potential predictors for long-term mortality.
Conclusion:
This study shows that total arterial no-touch aorta LIMA-RA Y-graft OPCAB as regular practice for all patients, regardless of age, is safe and effective. Our findings underline the strength of experience in a total arterial treatment strategy. Further research should identify risk factors influencing other outcomes after revascularization ensuring optimal outcomes across diverse patient populations.