# No-Touch Aorta Off-Pump LIMA-Radial Artery Y-Graft CABG as a Safe Strategy for All-Comers: Long-Term Survival

## TL;DR

This study shows that a specific heart bypass surgery technique is safe and effective for a wide range of patients, including older individuals.

## Contribution

The study demonstrates the long-term safety and effectiveness of a no-touch aorta, total arterial off-pump CABG technique for all-comers.

## Key findings

- In-hospital mortality was 0.6% with no significant differences across age groups.
- Five-year survival was 90% overall, with the youngest group having 98% and the oldest 65%.
- The mean number of grafts per patient was 3.7, consistent across age groups.

## Abstract

Objectives: To assess the long-term survival outcomes of patients undergoing no-touch aorta, total arterial off-pump coronary artery bypass grafting (OPCAB) using a left internal mammary artery (LIMA)–radial artery (RA) Y-graft configuration. This approach was applied uniformly to all-comers undergoing isolated CABG between 2004 and 2021, irrespective of preoperative risk profile. Methods: We included all patients treated with total arterial OPCAB using the LIMA–RA Y-graft without additional concomitant procedures. Patients were stratified into five age groups (<50, 50–59, 60–69, 70–79, and >80 years). Survival at 5 years was analyzed using Kaplan–Meier curves and Cox regression analysis. Results: A total of 2174 patients were analyzed, with a median follow-up of 3266 days. In-hospital mortality was 0.6%, whereas postoperative stroke was 0.3% without residual trauma and 0.2% with residual trauma, respectively, without differences between age groups. The mean number of grafts per patient was 3.7, with no significant variation between age groups (p = 0.09). Overall, 5-year survival was 90% (n = 1767), ranging from 98% in the youngest group to 65% in the oldest (log-rank p < 0.0001). Conclusions: No-touch aorta, total arterial OPCAB using the LIMA–RA Y-graft is a safe and effective revascularization strategy for a broad spectrum of patients, including those with advanced age and comorbidities.