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European Heart Journal Advance Access originally published online on March 6, 2009
European Heart Journal 2009 30(8):1005-1011; doi:10.1093/eurheartj/ehp048
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

One-year results of total arterial revascularization vs. conventional coronary surgery: CARRPO trial

Sune Damgaard1,*, Jørn Wetterslev2, Jens T. Lund1, Nikolaj B. Lilleør1, Mario J. Perko1, Henning Kelbæk3, Jan K. Madsen4 and Daniel A. Steinbrüchel1

1 Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
2 Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Denmark
3 Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
4 Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Denmark

Received 25 June 2008; revised 17 December 2008; accepted 22 January 2009; online publish-ahead-of-print 6 March 2009.

* Corresponding author. Tel: +45 35455560, Fax: +45 35452548, Email: sunedamgaard{at}dadlnet.dk

Aims: To investigate clinical and angiographic outcomes after coronary surgery using total arterial revascularization (TAR).

Methods and results: We randomized 331 patients with multivessel or isolated left main disease to TAR [internal thoracic (ITA) and radial arteries] vs. conventional revascularization (CR) using left ITA and vein grafts. The primary angiographic outcome was the patency index: number of patent grafts (<50% stenosed) divided by number of constructed grafts. One-year angiography was complete for 83% of patients. Mean patency index (±SD) was 87 ± 22% in the TAR group and 88 ± 18% in the conventional group (P = 0.52). In 72% of TAR patients and 67% of the conventional group, all grafts were patent (P = 0.45). Multiple imputation of missing angiographic data did not influence on results. Within 1 year, 37 (23%) TAR patients and 43 (25%) conventional group patients suffered cardiac events (HR 1.09, 95% CI 0.70–1.69, P = 0.70). One patient (0.6%) in the TAR group and two (1.2%) in the conventional group died (P = 1.00).

Conclusion: Within 1 year post-operatively, TAR seems at least as safe and effective as CR. Prolonged follow-up will reveal whether this is sustained or superior results of TAR can justify a more general use.

Key Words: Coronary surgery • Total arterial revascularization • Angiography • Clinical outcomes


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