ART Trial: Bilateral Grafts No Better? Experts Don't Believe Results

NOVEMBER 14, 2016
Gale Scott
A study comparing whether certain heart patients did better with bilateral arterial grafts than single grafts had the surprising result of finding no benefit at five years.

But researchers presenting the study and the experts who led a discussion of the results said they think if patients are followed for another five years or a decade or two, a benefit would emerge. Ten-year data will be available in 2018.

“There’s a growing conviction that bilateral arterial mammary grafts should be considered, “ said Timothy Gardner, MD, of Center for Heart & Vascular Health and Christiana Hospital in Newark, DE, moderating a panel discussion this morning at the American Heart Association’s Scientific Sessions 2016 in New Orleans, LA.

The bilateral procedure is performed in only about 5% of CABG cases in the US and 10% in Europe, but in Japan, 60% of the procedures are bilateral.
“We still think it has better potential assuming there are no co-morbidities,” Gardner said.

The study, known as ART was presented by David Taggart, MD, of the University of Oxford in Oxford, UK.

“We were also very surprised,” Taggart said at a news conference this morning.

The researchers looked at bilateral mammary artery coronary artery bypass grafting compared to standard single mammary artery grafting plus vein grafts.

All the patients had multi-vessel coronary artery disease. Their symptoms were New York Heart Association Class II to Class III.

Fifteen percent were smokers, 24% had diabetes, 42% had had a prior heart attack, and only 8% were non-Caucasian
.
Forty-one percent of the procedures were performed off-pump and that rate was similar in the two groups; 81% received 3 or more grafts.
 
Patients were followed for five years.

There were 3,102 patients, average 64 and 24% women who were scheduled for CABG. Of those 1,554 were scheduled for single grafts and 1,448 for bilateral grafts, procedures performed in 28 centers in seven countries.

The results were comparable in both groups.

In the single artery group the death rate was 8.4 % vs. 8.7% in the bilateral group.

Serious adverse events including death, heart attack and stroke was a composite rate of 12.7% for single artery grafting and it was 12.2% for those who got bilateral grafts.

There were more problems with surgical wound healing in the group that got bilateral grafts, particularly in diabetic patients.

The researchers said that they continue to believe that bilateral grafts are going to prove better for patients in the long run, if only because vein grafts used as part of the single internal mammary procedure are inherently not as strong as grafts from arteries. They predict they will see more vein graft failure after five years.


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