Grant: Operating Grant - PA: ICRH - New investigators (Bridge Funding)

Cardiac bypass grafting (CABG) surgery is an efficient way to provide blood to the vessels supplying the heart when these vessels are diseased, thus relieving chest pain and improving patient survival. The best CABG conduit, or graft, is an artery found behind the breastbone (LIMA) which is usually connected to an anterior heart vessel (LAD) supplying a large territory of the heart. We conceived an original technique to expand the reach of the LIMA to all the anterolateral territory using a short venous graft taken from the leg. Preliminary published data with this novel CABG technique are very promising with several added benefits: the blood flow in the LIMA is increased which may lead to better long-term patency (i.e. fewer occluded grafts); the delicate LIMA-to-LAD connection is easier to perform; and shorter venous grafts are required which is particularly useful when they are too short to reach their usual site of connection for blood inflow (aorta). We propose the clinical trial AMI-PONT to assess whether the results in term of graft patency with this novel CABG strategy are not inferior, or not worse, than a conventional CABG strategy combining separated LIMA-to-LAD graft and vein graft for other target vessels of the anterolateral territory. Two hundred CABG patients will be distributed at random in two groups and will undergo either the novel or the conventional CABG strategy. Patients will be followed for ten years, and will undergo at one year a noninvasive scan using X-rays to safely, quickly and precisely evaluate graft patency. We have strong reasons to believe that the novel CABG strategy provides non-inferior graft patency for the other anterolateral targets without untoward effects. This study could have a profound impact on the cardiac surgery field.