Interdiscip Cardiovasc Thorac Surg. 2026 Apr 15:ivag101. doi: 10.1093/icvts/ivag101. Online ahead of print.
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.
PMID:41984816 | DOI:10.1093/icvts/ivag101