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Narayan P. Is the COMPASS pointing towards clinical equipoise for the right internal mammary artery? Indian J Thorac Cardiovasc Surg 2023; 39:425-427. [PMID: 37346427 PMCID: PMC10279601 DOI: 10.1007/s12055-023-01516-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 06/23/2023] Open
Abstract
The right internal mammary artery (RIMA) has been considered the second-best graft after the left internal mammary artery by many. Recent guidelines have awarded class IIa recommendation for using the RIMA. The findings of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS)-coronary artery bypass grafting (CABG) sub-study showed a high graft failure rate for the RIMA. The findings of the study should initiate further scientific scrutiny of the RIMA and studies need to be carried out for further evaluation of the RIMA as a conduit.
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Affiliation(s)
- Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
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Alboom M, Browne A, Sheth T, Zheng Z, Dagenais F, Noiseux N, Brtko M, Stevens LM, Lee SF, Copland I, Power P, Eikelboom J, Lamy A. Conduit selection and early graft failure in coronary artery bypass surgery: A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) coronary artery bypass grafting study. J Thorac Cardiovasc Surg 2023; 165:1080-1089.e1. [PMID: 35760616 DOI: 10.1016/j.jtcvs.2022.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/22/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Relative rates of early graft failure and conduit selection in coronary artery bypass grafting (CABG) surgery remain controversial. Therefore, we sought to determine the incidence and determinants of graft failure of the left internal mammary artery (LIMA), radial artery, saphenous vein, and right internal mammary artery (RIMA) 1 year after CABG surgery. METHODS A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) CABG study, involving patients from 83 centers in 22 countries. We completed an analysis of 3480 grafts from 1068 patients who underwent CABG surgery with complete computed tomography angiography data. The primary outcome was graft failure as diagnosed by computed tomography angiography 1 year after surgery. RESULTS Graft failure occurred in 6.4% (68/1068) for LIMA, 9.9% (9/91) for radial artery, 10.4% (232/2239) for saphenous vein, and 26.8% (22/82) for RIMA grafts. The RIMA had a greater rate of graft failure (26.8%) than radial artery (9.9%) and veins (10.4%) (adjusted odds ratio, 2.69; 95% confidence interval, 1.30-5.57; P = .008 and adjusted odds ratio, 2.07; 95% confidence interval, 1.33-3.21; P = .001, respectively). CONCLUSIONS In this international trial dataset, LIMA and radial artery performed as expected, whereas vein grafts performed better. However, high rates of RIMA failure are worrisome and highlight the need for a thorough evaluation of the patency and safety of the RIMA in CABG surgery.
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Affiliation(s)
- Mariam Alboom
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Austin Browne
- Department of Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Tej Sheth
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Zhe Zheng
- Department of Cardiovascular Surgery, Fuwai Hospital, Beijing, China
| | - François Dagenais
- Department of Cardiac Surgery, Quebec Heart and Lung Institute affiliated with Laval University, Quebec City, Quebec, Canada
| | - Nicolas Noiseux
- Department of Cardiac Surgery, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Miroslav Brtko
- Department of Cardiac Surgery, Fakultní nemocnice Hradec Králové, Hradec Králové, Královéhradecký, Czech Republic
| | - Louis-Mathieu Stevens
- Department of Cardiac Surgery, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Shun Fu Lee
- Department of Statistics, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Ingrid Copland
- Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Patricia Power
- Department of Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - André Lamy
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada.
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Gaudino M, Lytle B. Right Internal Thoracic Artery for Coronary Bypass Surgery: Did We Get It Wrong? Circulation 2022; 146:1266-1267. [PMID: 36279413 DOI: 10.1161/circulationaha.122.061766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Mario Gaudino
- Department of Cardio-thoracic Surgery, Weill Cornell Medicine, New York (M.G.)
| | - Bruce Lytle
- Department of Cardiac and Thoracic Surgery, Baylor Scott & White, The Heart Hospital-Plano, TX (B.L.)
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Gaudino M, Di Franco A, Bhatt DL, Alexander JH, Abbate A, Azzalini L, Sandner S, Sharma G, Rao SV, Crea F, Fremes SE, Bangalore S. The association between coronary graft patency and clinical status in patients with coronary artery disease. Eur Heart J 2021; 42:1433-1441. [PMID: 33709098 DOI: 10.1093/eurheartj/ehab096] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/23/2020] [Accepted: 02/08/2021] [Indexed: 01/22/2023] Open
Abstract
The concept of a direct association between coronary graft patency and clinical status is generally accepted. However, the relationship is more complex and variable than usually thought. Key issues are the lack of a common definition of graft occlusion and of a standardized imaging protocol for patients undergoing coronary bypass surgery. Factors like the type of graft, the timing of the occlusion, and the amount of myocardium at risk, as well as baseline patients' characteristics, modulate the patency-to-clinical status association. Available evidence suggests that graft occlusion is more often associated with non-fatal events rather than death. Also, graft failure due to competitive flow is generally a benign event, while graft occlusion in a graft-dependent circulation is associated with clinical symptoms. In this systematic review, we summarize the evidence on the association between graft status and clinical outcomes.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA
| | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, 70 Francis St, Boston, MA 02115, USA
| | - John H Alexander
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt St, Durham, NC 27705, USA
| | - Antonio Abbate
- Division of Cardiology, VCU Pauley Heart Center and Wright Center for Clinical and Translational Research, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA 23219, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA 23219, USA
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Sunil V Rao
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt St, Durham, NC 27705, USA
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, Roma 00168, Italy
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Sripal Bangalore
- Division of Cardiology, NYU Langone Health, 27 W 86th St, New York, NY 10024, USA
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Rao V. Commentary: Harvesting the Internal Thoracic Artery: Let the skeletons Out of the Closet! Semin Thorac Cardiovasc Surg 2020; 33:21-22. [PMID: 33171251 DOI: 10.1053/j.semtcvs.2020.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Vivek Rao
- Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada.
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Ogawa S, Okawa Y. Reply to Seo and Cho. Eur J Cardiothorac Surg 2020; 59:ezaa281. [PMID: 32968757 DOI: 10.1093/ejcts/ezaa281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shinji Ogawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
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