Short-term Outcomes and Long-term Survival in Females after Single, Multiple, and Total Arterial Grafting

Abstract

Objective: Arterial grafting strategies in coronary artery bypass grafting (CABG) may influence outcomes, particularly in female patients, who remain underrepresented in cardiovascular research. This study aimed to evaluate short-term outcomes and long-term survival in females undergoing single arterial grafting (SAG), multiple arterial grafting (MAG), and total arterial grafting (TAG). Methods: A retrospective cohort of 2,093 female patients undergoing CABG was stratified into SAG (n=1,507), MAG (n=307), and TAG (n=279). Baseline demographics, procedural characteristics, and postoperative outcomes were compared using appropriate statistical tests. Long-term survival was assessed using inverse probability treatment weighted Cox regression, accounting for age, comorbidities, and extent of coronary artery disease. Results: TAG and MAG patients were significantly younger than SAG patients (p<0.001). TAG patients had fewer prior myocardial infarctions (p=0.003) and lower diabetes prevalence (p=0.003). Deep sternal wound infection was more frequent in TAG (7.2%) compared to SAG (2.6%, p=0.003). Thirty-day mortality and other short-term complications did not differ significantly across groups. Weighted Cox regression revealed no significant difference in long-term survival between grafting strategies (MAG HR=1.193, p=0.213; TAG HR=0.952, p=0.729). Age and prior cardiac surgery were independent predictors of mortality. The proportional hazards assumption was met (global test p=0.378), and Kaplan-Meier analysis confirmed comparable survival across groups (Wald χ²=0.56, p=0.755). Conclusion: In female patients undergoing CABG, TAG was associated with higher wound infection rates but did not confer a survival advantage over SAG or MAG. These findings support individualized arterial grafting strategies based on patient risk profiles and surgical judgment.