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Le NK, Mallick S, Chervu N, Butterfield J, Joachim K, Charland N, Coaston T, Vadlakonda A, Benharash P. Clinical and financial outcomes associated with the utilization of right internal mammary artery versus radial artery in multivessel coronary artery bypass grafting. Surgery 2024; 176:267-273. [PMID: 38782703 DOI: 10.1016/j.surg.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/30/2024] [Accepted: 04/06/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Multi-arterial coronary bypass grafting with the left internal mammary artery as a conduit has been shown to offer superior long-term survival compared to single-arterial coronary bypass grafting. Nevertheless, the selection of a secondary conduit between the right internal mammary artery and the radial artery remains controversial. Using a national cohort, we examined the relationships between the right internal mammary artery and the radial artery with acute clinical and financial outcomes. METHODS Adults undergoing on-pump multivessel coronary bypass grafting with left internal mammary artery as the first arterial conduit were identified in the 2016 to 2020 Nationwide Readmissions Database. Patients receiving either the right internal mammary artery or the radial artery, but not both, were included in the analysis. Multivariable regression models were fitted to examine the association between the conduits and in-hospital mortality, as well as additional secondary outcomes. RESULTS Of an estimated 49,798 patients undergoing multi-arterial coronary bypass grafting, 29,729 (59.7%) comprised the radial artery cohort. During the study period, the proportion of multi-arterial coronary bypass grafting utilizing the radial artery increased from 51.3% to 65.2% (nptrend <0.001). Following adjustment, the radial artery was associated with reduced odds of in-hospital mortality (adjusted odds ratio 0.44), prolonged mechanical ventilation (adjusted odds ratio 0.78), infectious complications (adjusted odds ratio 0.69), and 30-day nonelective readmission (adjusted odds ratio 0.77, all P < .05). CONCLUSION Despite no definite endorsement from surgical societies, the radial artery is increasingly utilized as a secondary conduit in multi-arterial coronary bypass grafting. Compared to the right internal mammary artery, the radial artery was associated with lower odds of in-hospital mortality, complications, and reduced healthcare expenditures. These results suggest that whenever feasible, the radial artery should be the favored conduit over the right internal mammary artery. Nevertheless, future studies examining long-term outcomes associated with these vessels remain necessary.
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Affiliation(s)
- Nguyen K Le
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA; David Geffen School of Medicine, UCLA, Los Angeles, CA. https://twitter.com/NguyenKLe18
| | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA; Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Jaron Butterfield
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA; Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Kole Joachim
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA; David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Nicole Charland
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA; David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Troy Coaston
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA; David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA; David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA; Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA.
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Moreno-Angarita A, Peña D, de León JDLP, Estacio M, Vila LP, Muñoz MI, Cadavid-Alvear E. Current indications and surgical strategies for myocardial revascularization in patients with left ventricular dysfunction: a scoping review. J Cardiothorac Surg 2024; 19:469. [PMID: 39068469 PMCID: PMC11282776 DOI: 10.1186/s13019-024-02844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/14/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Ischemic cardiomyopathy (ICM) accounts for more than 60% of congestive heart failure cases and is associated with high morbidity and mortality rates. Myocardial revascularization in patients with left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF) ≤35% aims to improve survival and quality of life and reduce complications associated with heart failure and coronary artery disease. The majority of randomized clinical trials have consistently excluded those patients, resulting in evidence primarily derived from observational studies. MAIN BODY We performed a scoping review using the Arksey and O'Malley methodology in five stages: 1) formulating the research question; 2) locating relevant studies; 3) choosing studies; 4) organizing and extracting data; and 5) compiling, summarizing, and presenting the findings. This literature review covers primary studies and systematic reviews focusing on surgical revascularization strategies in adult patients with ischemic left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF) of 35% or lower. Through an extensive search of Medline and the Cochrane Library, a systematic review was conducted to address three questions regarding myocardial revascularization in these patients. These questions outline the current knowledge on this topic, current surgical strategies (off-pump vs. on-pump), and graft options (including hybrid techniques) utilized for revascularization. Three independent reviewers (MAE, DP, and AM) applied the inclusion criteria to all the included studies, obtaining the full texts of the most relevant studies. The reviewers subsequently assessed these articles to make the final decision on their inclusion in the review. Out of the initial 385 references, 156 were chosen for a detailed review. After examining the full articles were examined, 134 were found suitable for scoping review. CONCLUSION The literature notes the scarcity of surgical revascularization in LVD patients in randomized studies, with observational data supporting coronary revascularization's benefits. ONCABG is recommended for multivessel disease in LVD with LVEF < 35%, while OPCAB is proposed for older, high-risk patients. Strategies like internal thoracic artery skeletonization harvesting and postoperative glycemic control mitigate risks with BITA in uncontrolled diabetes. Total arterial revascularization maximizes long-term survival, and hybrid revascularization offers advantages like shorter hospital stays and reduced costs for significant LAD lesions.
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Affiliation(s)
- Alejandro Moreno-Angarita
- Fundación Valle del Lili - Departamento de Cirugía - Servicio de Cirugía Cardiovascular, Carrera 98 No. 18-49, Cali, Valle del Cauca, 760032, Colombia
- Fundación Valle del Lili - Centro de Investigaciones Clínicas, Cali, Colombia
| | - Diego Peña
- Fundación Valle del Lili - Departamento de Cirugía - Servicio de Cirugía Cardiovascular, Carrera 98 No. 18-49, Cali, Valle del Cauca, 760032, Colombia.
| | | | - Mayra Estacio
- Fundación Valle del Lili - Departamento de Medicina Interna, Cali, Colombia
| | - Lidy Paola Vila
- Universidad Icesi - Departamento de Ciencias de la Salud, Cali, Colombia
| | - Maria Isabel Muñoz
- Universidad Icesi - Departamento de Ciencias de la Salud, Cali, Colombia
| | - Eduardo Cadavid-Alvear
- Fundación Valle del Lili - Departamento de Cirugía - Servicio de Cirugía Cardiovascular, Carrera 98 No. 18-49, Cali, Valle del Cauca, 760032, Colombia
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Momin A, Ranjan R, Valencia O, Jacques A, Lim P, Fluck D, Chua TP, Chandrasekaran V. Long Term Survival Benefits of Different Conduits Used in Coronary Artery Bypass Graft Surgery- A Single Institutional Practice Over 20 Years. J Multidiscip Healthc 2024; 17:1505-1512. [PMID: 38617079 PMCID: PMC11011645 DOI: 10.2147/jmdh.s461567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024] Open
Abstract
Objective This study determined hazard factors and long-term survival rate of total arterial coronary artery bypass graft surgery over 20 years in an extensively large, population-based cohort. Methods A total of 2979 patients who underwent isolated CABG from April 1999 to March 2020 were studied in 4 groups- Group-A (bilateral internal mammary artery ± radial artery), Group-B (single internal mammary artery + radial artery ± saphenous vein), Group-C (single internal mammary artery ± saphenous vein; no radial artery), and Group-D (radial artery ± saphenous vein; no internal mammary artery). The study endpoints analysed the correlation between the number and types of grafts with the survival time following isolated CABG surgery. Results The total arterial revascularization (Group A) group had an admirable mean long-term survival of ~19 years, compared to 18.6 years (Group B), 15.86 years (Group C), and 10.99 years (Group D). A Kaplan-Meier curve demonstrated confidence interval (CI) for study groups- (95% CI 18.33-19.94), (95% CI 18.14-19.06), (95% CI 15.40-16.32), and (95% CI 9.61-12.38) in Group A, B, C, D respectively. In the Holm-Sidak method analysis, significant associations existed between the number of arterial grafts and the long-term outcome. A statistically significant (P≤0.05) long-term survival advantage for arterial grafting was demonstrated, especially total arterial revascularisation over all other combinations except single internal mammary artery + radial artery grafting. Conclusion In this series, over 20 years, total arterial CABG use has excellent long-term survival, achieving complete myocardial revascularisation. There is no significant difference between the BIMA group and SIMA with radial artery. However, there is a reduced survival with decreased use of arterial conduits.
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Affiliation(s)
- Aziz Momin
- Department of Cardiac Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Redoy Ranjan
- Department of Cardiac Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK
- Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Oswaldo Valencia
- Department of Cardiac Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Adam Jacques
- Department of Cardiology, Ashford and St Peter’s Hospitals NHS Foundation Trust, London, UK
| | - Pitt Lim
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter’s Hospitals NHS Foundation Trust, London, UK
| | - Tuan P Chua
- Department of Cardiology, Royal Surrey NHS Foundation Trust, London, UK
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Du H, Gu X, Zhang Z, Dong Z, Ran X, Zhou L. Effect of right internal mammary artery versus radial artery as a second graft vessel in coronary artery bypass grafting on postoperative wound infection in patients: A meta-analysis. Int Wound J 2024; 21:e14592. [PMID: 38424286 PMCID: PMC10904365 DOI: 10.1111/iwj.14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 03/02/2024] Open
Abstract
Few studies have shown that radial artery (RA), which is used as a secondary arterial graft, offers superior results compared with right internal thoracic artery (RIMA) in coronary artery bypass grafting (CABG). In a meta-analysis of observational studies starting in 2023, we looked at the effect of re-operation on postoperative infection and haemorrhage in CABG with RA vs. RIMA. The electronic database up to October 2023 was examined in the course of the research. Analysis was carried out on the clinical trials of postoperative wound infections and haemorrhage re-surgery. Among 912 trials associated with CABG, we selected 8 trials to be included in the final data analysis. The main results were secondary wound infection and re-operation after surgery. The odds ratios (OR) and confidence intervals (CIs) were computed on the basis of a randomized or fixed-effect model of wound infection and re-operation. Seven trials showed a significant reduction in the risk of wound infection in RA treated as a secondary artery transplant compared with RIMA (OR, 1.60; 95% CI, 1.03, 2.47 p = 0.04); Four trials showed that RIMA was not significantly different from RA in the rate of re-operation for postoperative bleeding (OR, 1.31; 95% CI, 0.60, 2.88 p = 0.50). In CABG, RA is used as a secondary arterial conduit graft to lower the risk of wound infection in CABG patients.
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Affiliation(s)
- Hong Du
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Xiaowei Gu
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Zhiyuan Zhang
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Zichao Dong
- Department of Cardio SurgeryWuHan Asia Cardiac Disease HospitalWuhanChina
| | - Xiaofei Ran
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Li Zhou
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
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Urso S, Sadaba R, González Martín JM, Nogales E, Tena MÁ, Portela F. Bilateral internal thoracic artery versus single internal thoracic artery plus radial artery: A double meta-analytic approach. J Thorac Cardiovasc Surg 2024; 167:183-195.e3. [PMID: 35437176 DOI: 10.1016/j.jtcvs.2022.03.010] [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: 10/01/2021] [Revised: 02/19/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We explored the current evidence on the best second conduit in coronary surgery carrying out a double meta-analysis of propensity score matched or adjusted studies comparing bilateral internal thoracic artery (BITA) versus single internal thoracic artery plus radial artery. METHODS PubMed, Embase, and Google Scholar were searched for propensity score matched or adjusted studies comparing BITA versus single internal thoracic artery plus radial artery. The end point was long-term mortality. Two statistical approaches were used: the generic inverse variance method and the pooled meta-analysis of Kaplan-Meier-derived individual patient data. RESULTS Twelve matched populations comparing 6450 patients with BITA versus 9428 patients with single internal thoracic artery plus radial artery were included in our meta-analysis. The generic inverse variance method showed a statistically significant survival benefit of the BITA group (hazard ratio, 0.84; 95% CI, 0.74-0.95; P = .04). The Kaplan-Meier estimates of survival at 1, 5, 10, and 15 years of the BITA group were 97.0%, 91.3%, 80.0%, and 68.0%, respectively. The Kaplan-Meier estimates of survival at 1, 5, 10, and 15 years of the single internal thoracic artery plus radial artery group were 97.3%, 91.5%, 79.9%, and 63.9%, respectively. The Kaplan-Meier-derived individual patient data meta-analysis applied to very long follow-up time data, showed that BITA provided a survival benefit after 10 years from surgery (hazard ratio, 0.77; 95% CI, 0.63-0.94; P = .01). No differences in terms of survival between the 2 groups were detected when the analysis was focused on the first 10 years of follow-up (hazard ratio, 0.99; 95% CI, 0.91-1.09; P = .93). CONCLUSIONS The present meta-analysis suggests that double internal thoracic artery may provide, compared with single internal thoracic artery plus radial artery, a statistically significant survival advantage after 10 years of follow-up, but not before. VIDEO ABSTRACT.
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Affiliation(s)
- Stefano Urso
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain.
| | - Rafael Sadaba
- Cardiac Surgery Department, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Eliú Nogales
- Cardiology Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - María Ángeles Tena
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Francisco Portela
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
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Ren J, Tian DH, Gaudino M, Fremes S, Reid CM, Vallely M, Smith JA, Srivastav N, Royse C, Royse A. Survival Benefit of Multiple Arterial Revascularization With and Without Supplementary Saphenous Vein Graft. J Am Heart Assoc 2023; 12:e031986. [PMID: 37947115 PMCID: PMC10727302 DOI: 10.1161/jaha.123.031986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
Background It is unknown if the presence of saphenous vein grafting (SVG) adversely affects late survival following coronary surgery with multiple arterial grafting (MAG) versus single arterial grafting. Methods and Results A retrospective, observational, multicenter cohort study from 2001 to 2020 was conducted using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database linked to the National Death Index. Patients undergoing primary isolated coronary artery bypass grafting with ≥2 grafts were included, and exclusions were patients aged <18 years, reoperations, concomitant or previous cardiac surgery, and the absence of arterial grafting. Demographics, comorbidities, medication, and operative configurations were propensity score matched between cohorts. The primary outcome was all-cause late death. Of 59 689 eligible patients, 35 113 were MAG (58.8%), and 24 576 were single arterial grafting (41.2%). Of the MAG cohort, 17 055 (48.6%) patients did not receive supplementary SVG (total arterial revascularization). Matching separately generated 22 764 patient pairs for MAG versus single arterial grafting, and 11 137 patient pairs for MAG with total arterial revascularization versus MAG with ≥1 supplementary vein grafts. At a median follow-up duration of 5.0 years postoperatively, the mortality rate was significantly lower for MAG than single arterial grafting (hazard ratio [HR], 0.79 [95% CI, 0.76-0.83]; P<0.001). The stratified MAG analysis found that MAG with total arterial revascularization had a lower risk of late death (HR, 0.85 [95% CI, 0.80-0.91]; P<0.001) compared with MAG with ≥1 supplementary vein grafts. Sensitivity analyses produced consistent outcomes as the primary analysis. Following adjustment for the presence of SVG in the Cox model, the survival advantage of incremental number of arteries was lost. Conclusions Multiple arterial grafting has significantly improved long-term survival compared with single arterial grafting. A further incremental survival benefit exists when no SVG is used.
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Affiliation(s)
- Justin Ren
- SurgeryUniversity of MelbourneMelbourneAustralia
| | - David H. Tian
- SurgeryUniversity of MelbourneMelbourneAustralia
- Anesthesia, Westmead HospitalSydneyAustralia
| | - Mario Gaudino
- Cardiothoracic Surgery, Weill Cornell MedicineNew YorkNY
| | | | | | - Michael Vallely
- Cardiothoracic SurgeryVictorian Heart Hospital and Monash UniversityMelbourneAustralia
| | - Julian A. Smith
- Cardiothoracic SurgeryVictorian Heart Hospital and Monash UniversityMelbourneAustralia
| | | | - Colin Royse
- SurgeryUniversity of MelbourneMelbourneAustralia
- Outcomes Research ConsortiumCleveland ClinicClevelandOH
- AnesthesiaRoyal Melbourne HospitalMelbourneAustralia
| | - Alistair Royse
- SurgeryUniversity of MelbourneMelbourneAustralia
- Cardiothoracic Surgery, Royal Melbourne HospitalMelbourneAustralia
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Momin A, Ranjan R, Chandrasekaran V. Is complete myocardial revascularisation with total arterial coronary artery bypass graft a dream or reality? Health Sci Rep 2023; 6:e1532. [PMID: 37636291 PMCID: PMC10447915 DOI: 10.1002/hsr2.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Aziz Momin
- Department of Cardiac SurgerySt George's University Hospitals NHS Foundation TrustLondonUK
| | - Redoy Ranjan
- Department of Cardiac SurgerySt George's University Hospitals NHS Foundation TrustLondonUK
- Department of Cardiac SurgeryBangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
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Barili F, Onorati F, D'Errigo P, Rosato S, Biancari F, Baglio G, Badoni G, Parolari A, Seccareccia F. Bilateral Internal Thoracic Arteries Improve 10-Year Outcomes of Coronary Artery Bypass Grafting. Ann Thorac Surg 2023; 116:52-60. [PMID: 36822528 DOI: 10.1016/j.athoracsur.2023.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/14/2023] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND This observational cohort study was designed by the PRIORITY (PRedictIng long-term Outcomes afteR Isolated coronary arTery bypass surgery) steering committee to evaluate the 10-year follow-up outcome of bilateral internal thoracic arteries (BITA) versus single internal thoracic artery. METHODS The PRIORITY project was designed to evaluate long-term outcome of 2 large prospective multicenter cohort studies of coronary artery bypass grafting. Clinical data on isolated coronary artery bypass grafting were merged with administrative data to collect follow-up information. The primary endpoint was the composite outcome of major adverse cardiac and cerebrovascular events at 10-year follow-up. Secondary endpoints were individual components of major adverse cardiac and cerebrovascular events at 10 years and surgical site complications or infections. A propensity score-based inverse probability treatment weighting (IPTW) was used to overcome the selection bias related to the observational nature of the study. RESULTS The study population consisted of 10,988 patients who underwent isolated coronary artery bypass grafting. BITA was used in 23.5%. The use of BITA is related to lower incidence of major adverse cardiac and cerebrovascular events at 10 years (adjusted hazard ratio [HR] 0.88, 95% CI 0.79-0.98, P < .001). BITA correlated with better 10-year survival (IPTW adjusted HR 0.87, 95% CI 0.78-1.00, P = .05), re-revascularization (IPTW adjusted HR 0.83, 95% CI 0.74-0.92, P < .001), and myocardial infarction (IPTW adjusted HR 0.86, 95% CI 0.77-0.95, P = .005) but to increased incidence of surgical site complications or infections (HR 2.12, 95% CI 1.39-3.24, P < .001). CONCLUSIONS In propensity-matched patients, use of BITA was associated with improved 10-year survival, freedom from repeat revascularization, and myocardial infarction but also higher incidence of surgical site complications.
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Affiliation(s)
- Fabio Barili
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | | | - Paola D'Errigo
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Unit of Surgery, Anesthesiology, and Critical Care, University of Oulu, Oulu, Finland
| | | | - Gabriella Badoni
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Alessandro Parolari
- University Unit of Cardiac Surgery, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Italian Health Institute, Rome, Italy
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Ren J, Royse C, Srivastav N, Lu O, Royse A. Long-Term Survival of Multiple Versus Single Arterial Coronary Bypass Grafting in Elderly Patients. J Clin Med 2023; 12:2594. [PMID: 37048677 PMCID: PMC10094898 DOI: 10.3390/jcm12072594] [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: 02/12/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Multiple arterial grafting (MAG) utilizes more than one arterial graft with any additional grafts being saphenous vein grafts (SVG). It remains an infrequently used coronary surgical revascularization technique, especially in elderly patients. Our study aims to evaluate the age-related association with the relative outcomes of multiple versus single arterial grafting (SAG). The Australian and New Zealand national registry was used to identify adult patients undergoing primary isolated CABG with at least two grafts. Exclusion criteria included reoperations, concomitant or previous cardiac surgery, and the absence of arterial grafting. Propensity score matching was used to match patient groups. The primary outcome was all-cause late mortality and the secondary outcomes were 30-day mortality and 30-day hospital readmission. We selected 69,624 eligible patients with a mean (standard deviation) age of 65.0 (10.2) years old. Matching between MAG and SAG generated 16,882 pairs of patients < 70 years old and 10,921 pairs of patients ≥ 70 years old. At a median [interquartile range] follow-up duration of 5.9 [3.2-9.6] years, MAG was associated with significantly reduced mortality compared to SAG (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.68-0.78; p < 0.001) in the younger subgroup as well as the elderly subgroup (HR, 0.84; 95% CI, 0.79-0.88; p < 0.001). In conclusion, MAG offers a survival benefit over SAG, in both younger and elderly patients.
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Affiliation(s)
- Justin Ren
- Department of Surgery, University of Melbourne, Melbourne 3050, Australia
| | - Colin Royse
- Department of Surgery, University of Melbourne, Melbourne 3050, Australia
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne 3050, Australia
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Nilesh Srivastav
- Department of Surgery, University of Melbourne, Melbourne 3050, Australia
| | - Oscar Lu
- Oxford Medical School, Medical Sciences Division, University of Oxford, Oxford OX1 2JD, UK
| | - Alistair Royse
- Department of Surgery, University of Melbourne, Melbourne 3050, Australia
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne 3050, Australia
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Aboul-Hassan SS, Stankowski T, Marczak J, Perek B, Olasinska-Wisniewska A, Urbanowicz T, Jemielity M, Moskal L, Majchrowicz W, Sá MP, Awad AK, Torregrossa G, Ramlawi B, Cichon R. Long-term outcomes of patients receiving right internal thoracic artery or radial artery as a second arterial conduit. A propensity score matching study. Int J Cardiol 2023; 370:136-142. [PMID: 36328116 DOI: 10.1016/j.ijcard.2022.10.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study aimed to compare the long-term outcomes in propensity matched patients receiving right internal thoracic artery(RITA) or radial artery(RA) as second arterial conduit during coronary artery bypass grafting(CABG) with internal thoracic artery to the left anterior descending artery(LAD). METHODS In this retrospective study, propensity score matching was performed including 1198 patients from 3 centers resulting in 389-pairs who received either RITA or RA. RESULTS In the matched cohort, median follow-up time was 7.53 years(interquartile range, 4.35-11.81). Survival probabilities at 5, 10 and 15-years were 93.8% versus 94.5%, 81.2% versus 76.2% and 63.2% vs 62.5% in the RITA and RA groups, respectively(HR: 1.11; 95%CI;0.80-1.53; P = 0.533) Freedom from MACCE in the matched cohort at 5, 10 and 15-years were 92.0% versus 93.7%, 75.0% versus 73.8%, 72.2% and 46.9% vs 47.2% in the RITA and RA groups, respectively(HR: 0.96; 95%CI;0.74-1.26; P = 0.774). Subgroup analyses of the matched cohort showed comparable long-term outcomes in terms of MACCE at follow-up in patients with age older than 65-years, obese patients, diabetics, female patients and with impaired EF. As for target vessel revascularization, RITA and RA had comparable outcomes in terms of MACCE when the conduit was used to graft either the left coronary system or the right coronary system. CONCLUSIONS The use of RITA or RA as second arterial conduit during CABG with internal thoracic artery to the LAD is safe and associated with comparable long-term clinical outcomes. The choice of optimal second arterial conduit should be guided mainly by patients' characteristics and surgeons' preferences.
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Affiliation(s)
- Sleiman Sebastian Aboul-Hassan
- Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland; Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland.
| | - Tomasz Stankowski
- Department of Cardiac Surgery, Sana-Heart Center Cottbus, Cottbus, Germany
| | - Jakub Marczak
- Department of Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, UK
| | - Bartlomiej Perek
- Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Olasinska-Wisniewska
- Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Urbanowicz
- Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Lukasz Moskal
- Department of Cardiac Surgery, MEDINET Heart Center Ltd, Wroclaw, Poland
| | - Weronika Majchrowicz
- Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland; Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland
| | - Michel Pompeu Sá
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA; Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Ahmed K Awad
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA; Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Gianluca Torregrossa
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA; Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Basel Ramlawi
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA; Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Romuald Cichon
- Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland; Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland; Department of Cardiac Surgery, MEDINET Heart Center Ltd, Wroclaw, Poland
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11
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Vesnina ZV, Grakova EV. Diagnostic radiology methods for assessing coronary artery bypass graft viability. BULLETIN OF SIBERIAN MEDICINE 2022. [DOI: 10.20538/1682-0363-2022-3-140-153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The review describes available modern radiological methods which are currently applied for a detailed and comprehensive anatomical and functional assessment of the viability of various coronary artery bypass grafts. In addition, it presents some aspects of the implementation of these methods and clinical interpretation of the results.
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Affiliation(s)
- Zh. V. Vesnina
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
| | - E. V. Grakova
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
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12
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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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13
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Zuo HJ, Nan N, Yang HX, Wang JW, Song XT. Impact of Conventional Cardiovascular Risk Factors on Left Internal Mammary Artery Graft Disease. Front Cardiovasc Med 2022; 8:705765. [PMID: 35096986 PMCID: PMC8795621 DOI: 10.3389/fcvm.2021.705765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background:The development of atherosclerosis was considered as the common cause of the stenosis of coronary artery grafts. Left internal mammary artery (LIMA) was the best artery graft for further effectiveness of coronary artery bypass grafting (CABG). We sought to assess the impact of known conventional cardiovascular risk factors (RFs) on LIMA graft stenosis.Methods:A retrospective study including 618 participants, who had recurrence of chest pain after CABG, aged ≥18 years, hospitalized for coronary angiography in Beijing Anzhen hospital between 2010 and 2017 was performed. All the participants were confirmed to have LIMA graft. Multivariate analysis was conducted to determine the relationship between conventional RFs and LIMA graft stenosis.Results:Of the study, 220 (35.6%) participants continued to smoke, 504 (81.6%) were overweight or obese, and 411 (66.5%) and 242 (39.2%) reported concomitant hypertension and diabetes, respectively. LIMA graft stenosis occurred in 161 participants (26.1%). Postoperative smoking, a CABG duration of ≥10 years and hyperglycemia without diabetes had an increased risk of LIMA graft stenosis, the odds ratio (OR) was 1.86 [95% confidence interval (CI): 1.26–2.78], 2.24 (95%CI:1.33–3.478), and 2.44(95% CI:1.39–4.32), respectively. Statin use (OR, 0.28; 95% CI: 0.25–0.5) and low-density lipoprotein cholesterol (LDL-C) < 1.8 mmol/L (OR, 0.27; 95% CI: 0.14–0.53) had a significantly decreased risk of LIMA graft stenosis. While, only 15.4% (95/618) achieved the target LDL-C level.Conclusions:Postoperative smoking and hyperglycemia without diabetes had an increased risk of LIMA graft stenosis. Statin use and LDL-C <1.8 mmol/L decreased the risk.
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Affiliation(s)
- Hui-Juan Zuo
- Department of Community Health Research, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
- *Correspondence: Hui-Juan Zuo
| | - Nan Nan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong-Xia Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jin-Wen Wang
- Department of Community Health Research, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Xian-Tao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Xian-Tao Song
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14
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Shimahara Y, Fukushima S, Kawamoto N, Tadokoro N, Nakai M, Kobayashi J, Fujita T. Additional survival benefit of bilateral in situ internal thoracic artery grafting with composite radial artery graft in total arterial off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01733-5. [PMID: 35012781 DOI: 10.1016/j.jtcvs.2021.11.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/26/2021] [Accepted: 11/29/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aimed to elucidate whether the use of bilateral internal thoracic arteries (BITAs) confers additional survival benefits compared with a single internal thoracic artery (SITA) in total arterial grafting with the radial artery. METHODS Between 2002 and 2016, 617 patients underwent a bilateral in situ internal thoracic artery grafting with the radial artery as a composite I-graft (BITA-I group) and 516 patients underwent single in situ internal thoracic artery grafting with the radial artery as a composite Y-graft (SITA-Y group). All anastomoses were performed without cardiopulmonary bypass and aortic manipulation. Propensity score matching was performed to adjust covariates and compared the outcomes between the 2 groups. Subanalysis was also performed to evaluate the effects of the BITA-I group on survival according to the covariates using Cox proportional hazards regression analysis. RESULTS Propensity score matching yielded 348 well-matched pairs. Early postoperative outcomes were similar in the 2 groups. The BITA-I group showed significantly better survival than the SITA-Y group (79.3% vs 70.2% at 10 years, P = .015). The subanalysis revealed a significantly better survival in the BITA-I group among overall patients (hazard ratio, 0.68; 95% confidence interval, 0.49-0.93). There was a significant positive effect on survival in the BITA-I group among patients without comorbidities or those aged <77 years. CONCLUSIONS BITA grafting with the radial artery provides better long-term survival than SITA grafting with the radial artery, which is enhanced among patients aged <77 years with minimum comorbidities.
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Affiliation(s)
- Yusuke Shimahara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Naonori Kawamoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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15
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Rickel AP, Deng X, Engebretson D, Hong Z. Electrospun nanofiber scaffold for vascular tissue engineering. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 129:112373. [PMID: 34579892 DOI: 10.1016/j.msec.2021.112373] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022]
Abstract
Due to the prevalence of cardiovascular diseases, there is a large need for small diameter vascular grafts that cannot be fulfilled using autologous vessels. Although medium to large diameter synthetic vessels are in use, no suitable small diameter vascular graft has been developed due to the unique dynamic environment that exists in small vessels. To achieve long term patency, a successful tissue engineered vascular graft would need to closely match the mechanical properties of native tissue, be non-thrombotic and non-immunogenic, and elicit the proper healing response and undergo remodeling to incorporate into the native vasculature. Electrospinning presents a promising approach to the development of a suitable tissue engineered vascular graft. This review provides a comprehensive overview of the different polymers, techniques, and functionalization approaches that have been used to develop an electrospun tissue engineered vascular graft.
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Affiliation(s)
- Alex P Rickel
- The Department of Biomedical Engineering, The University of South Dakota, Sioux Falls, SD 57107, United States of America
| | - Xiajun Deng
- The Department of Biomedical Engineering, The University of South Dakota, Sioux Falls, SD 57107, United States of America
| | - Daniel Engebretson
- The Department of Biomedical Engineering, The University of South Dakota, Sioux Falls, SD 57107, United States of America
| | - Zhongkui Hong
- The Department of Biomedical Engineering, The University of South Dakota, Sioux Falls, SD 57107, United States of America.
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16
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Milutinovic AV, Krasic SD, Zivkovic IS, Cirkovic AM, Lokas SZ, Jovanovic MM, Milojevic PS, Peric MS. Prediction value of EuroSCORE II in total arterial revascularization and its usage in the evaluation of postoperative complications: Single-center experience. Asian Cardiovasc Thorac Ann 2021; 29:903-909. [PMID: 33611947 DOI: 10.1177/0218492321997057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Total arterial revascularization is the most durable and technically the most demanding type of coronary artery bypass grafting procedure. It has proven long-term supremacy in comparison to conventional coronary artery bypass grafting. In our study, we investigated the reliability of EuroSCORE II as a predictor of intrahospital death. We showed its impact on adverse perioperative events. METHODS In this nonrandomized prospective study, we analyzed 116 consecutive patients who underwent the total arterial revascularization procedure at our Institute from January 2011 until the present. For myocardial revascularization, the most suitable combinations with left internal mammary artery, right internal mammary artery, and radial artery grafts were used. Main fact in this research was intrahospital mortality value in comparison with the value predicted. RESULTS There were 104 (89.7%) males and 12 (10.3%) females. Mean preoperative EuroSCORE II prediction value was 1.98% and postoperative we obtained 1.72%. Postoperative redo for bleeding was 6%. Positive correlation was proven between the EuoroSCORE II value and intensive care unit stay (0.452; p < 0.001). Among patients who received two internal mammary arteries, the highest EuroSCORE II was among those with presternal wound infection (p = 0.005). Patients with bilateral internal mammary arteries and diabetes showed that they have the highest values of EuroSCORE II and, at the same time, that they are extremely prone to wound problems. CONCLUSIONS We achieved a lower intrahospital mortality level than it was predicted with preoperative EuroSCORE II value. This tool is a reliable method for preoperative death risk calculation in this group of patients.
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Affiliation(s)
| | - Stasa D Krasic
- Department of Pediatric Cardiology, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia
| | - Igor S Zivkovic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | | | - Slobodan Z Lokas
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Milos M Jovanovic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Predrag S Milojevic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia.,School of Medicine, Belgrade University, Belgrade, Serbia
| | - Miodrag S Peric
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia.,School of Medicine, Belgrade University, Belgrade, Serbia
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17
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Di Bacco L, Repossini A, Muneretto C, Torkan L, Bisleri G. Long-Term Outcome of Total Arterial Myocardial Revascularization Versus Conventional Coronary Artery Bypass in Diabetic and Non-Diabetic Patients: A Propensity-Match Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:580-587. [DOI: 10.1016/j.carrev.2019.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
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18
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Torregrossa G, Amabile A, Williams EE, Fonceva A, Hosseinian L, Balkhy HH. Multi-arterial and total-arterial coronary revascularization: Past, present, and future perspective. J Card Surg 2020; 35:1072-1081. [PMID: 32293059 DOI: 10.1111/jocs.14537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/09/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Although abundant biological, clinical, and scientific evidence exists on the superiority of multi-arterial (MAR) and total-arterial revascularization (TAR) over the conventional strategy with a single internal thoracic artery, only 10% of patients undergoing coronary artery bypass grafting (CABG) in the United States receives a second arterial conduit, and only 5% of patients receives TAR. METHODS AND RESULTS In January 2020, the authors performed comprehensive search to identify studies that evaluated MAR and TAR strategies through the MEDLINE database. CONCLUSIONS In this paper, the authors reviewed the literature on the historical and current evidence in favor of MAR and TAR, thus underlying why current CABG practice needs qualitative improvement.
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Affiliation(s)
- Gianluca Torregrossa
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Elbert E Williams
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York City, New York
| | - Ana Fonceva
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Leila Hosseinian
- Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, Chicago, Illinois
| | - Husam H Balkhy
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
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19
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Özdemir HI, van Dijk CHB, Özdemir AB, van Straten BHM, Haanschoten M, Soliman-Hamad MA. Preventing spasm of the radial artery conduit during coronary artery bypass grafting: Nicardipine versus verapamil. J Card Surg 2019; 34:1505-1510. [PMID: 31794130 DOI: 10.1111/jocs.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY In vitro studies have shown a reduction in radial artery spasm with the use of calcium antagonists. The purpose of this study was to evaluate the efficacy of topical treatment of the radial artery conduit using either verapamil or nicardipine before the anastomoses. METHODS This prospective randomized study included 131 patients, who underwent coronary artery bypass grafting surgery with the use of the radial artery as a conduit. In 65 patients, the harvested radial artery was topically treated with verapamil and in 66 patients with nicardipine. After harvesting the radial artery, the direct flow through the conduit was measured in vitro before 5-minute incubation in nicardipine or verapamil and measured again after incubation. The flow before and after incubation was compared. Postincubation flow was also compared in the two groups. After performing the anastomosis, the flow through the radial artery was measured in vivo. RESULTS The mean flow after NaCl incubation was 19.93 ± 12.66 mL/min and after incubation in the Ca+ channel blocker 47.16 ± 14.58 mL/min (P < .001). No significant difference in postincubation free flow was found between verapamil (46.29 ± 15.43 mL/min) and nicardipine (48.01 ± 13.77 mL/min; P = .503). CONCLUSION Topical treatment with Ca+ channel blockers reduces radial artery spasm and significantly increases the free flow through the radial artery conduit. Nicardipine is a safe and effective alternative of verapamil in preventing spasm of radial artery conduit.
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Affiliation(s)
- H Ibrahim Özdemir
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Carola H B van Dijk
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Bart H M van Straten
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Marco Haanschoten
- Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands
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20
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Jannati M, Navaei MR, Ronizi LG. A comparative review of the outcomes of using arterial versus venous conduits in coronary artery bypass graft (CABG). J Family Med Prim Care 2019; 8:2768-2773. [PMID: 31681641 PMCID: PMC6820417 DOI: 10.4103/jfmpc.jfmpc_367_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/05/2019] [Accepted: 08/28/2019] [Indexed: 01/01/2023] Open
Abstract
Nowadays one of the most frequent reasons of death in the world is coronary artery disease. CABG is a portion of a common revascularization mediation that is done to supervise CAD by applying vessels that are grafted to revascularize vessels distal from the blockage. Different sources of grafts are included veins (specifically saphenous) and arteries (include mammary and radial arteries). Multiple conduits are used to this end, but the most suitable is left internal mammary artery (LIMA) to the left anterior descending artery (LAD) as a golden standard. Saphenous vein grafts were the guiding approach applied by the vast majority of cardiac surgeons in the 1970s, even though all approaches were supported by doctors. Although the radial artery graft was introduced simultaneously, this approach due to its complications was not as prevalent. This article is aimed to define the pros and cons of applying each kind of grafts according to the results furnished by existent studies. It has also examined the benefits provided by total arterial coronary artery bypass graft against CABG including venous graft for patients with CAD from the perspective of surgeons.
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Affiliation(s)
- Mansour Jannati
- Department of Cardiovascular Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Rafati Navaei
- Department of Cardiovascular Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Ghaedian Ronizi
- Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran
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21
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Multiarterial coronary artery bypass grafting: is the radial artery fulfilling the unkept promise of the right internal thoracic artery? Curr Opin Cardiol 2019; 34:628-636. [PMID: 31389824 DOI: 10.1097/hco.0000000000000670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW The debate on the second best conduit for CABG is still intense. In this review, we discuss the role of the radial artery and the right internal thoracic artery (RITA) compared with saphenous vein grafts (SVG). RECENT FINDINGS The recent RADIAL STUDY has been the first evidence based on randomized trials of a clinical benefit using a second arterial graft in CABG.On the other hand, the definitive 10-year results of the ART trial failed to show a clinical advantage associated with the use of bilateral internal thoracic artery (BITA). A thorough and contextualized analysis of this and other studies, however, may offer a different perspective. SUMMARY Arterial conduits in CABG have shown better patency rates than SVG. Whether this leads to better clinical outcomes is still debated. In this setting, the radial artery and the RITA seem to offer a similar advantage, although with different indications and contraindications.
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22
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Urso S, Nogales E, González JM, Sadaba R, Tena MÁ, Bellot R, Ríos L, Portela F. Bilateral internal thoracic artery versus single internal thoracic artery: a meta-analysis of propensity score-matched observational studies. Interact Cardiovasc Thorac Surg 2019; 29:163–172. [PMID: 30848794 DOI: 10.1093/icvts/ivz037] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/21/2018] [Accepted: 01/23/2019] [Indexed: 11/12/2022] Open
Abstract
The lack of benefit in terms of mid-term survival and the increase in the risk of sternal wound complications published in a recent randomized controlled trial have raised concerns about the use of bilateral internal thoracic artery (BITA) in myocardial revascularization surgery. For this reason, we decided to explore the current evidence available on the subject by carrying out a meta-analysis of propensity score-matched studies comparing BITA versus single internal thoracic artery (SITA). PubMed, EMBASE and Google Scholar were searched for propensity score-matched studies comparing BITA versus SITA. The generic inverse variance method was used to compute the combined hazard ratio (HR) of long-term mortality. The DerSimonian and Laird method was used to compute the combined risk ratio of 30-day mortality, deep sternal wound infection and reoperation for bleeding. Forty-five BITA versus SITA matched populations were included. Meta-analysis showed a significant benefit in terms of long-term survival in favour of the BITA group [HR 0.78; 95% confidence interval (CI) 0.71-0.86]. These results were consistent with those obtained by a pooled analysis of the matched populations comprising patients with diabetes (HR 0.65; 95% CI 0.43-0.99). When compared with the use of SITA plus radial artery, BITA did not show any significant benefit in terms of long-term survival (HR 0.86; 95% CI 0.69-1.07). No differences between BITA and SITA groups were detected in terms of 30-day mortality or in terms of reoperation for bleeding. Compared with the SITA group, patients in the BITA group had a significantly higher risk of deep sternal wound infection (risk ratio 1.66; 95% CI 1.41-1.95) even when the pooled analysis was limited to matched populations in which BITA was harvested according to the skeletonization technique (risk ratio 1.37; 95% CI 1.04-1.79). The use of BITA provided a long-term survival benefit compared with the use of SITA at the expense of a higher risk of sternal deep wound infection. The long-term survival advantage of BITA is undetectable when compared with SITA plus radial artery.
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Affiliation(s)
- Stefano Urso
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Eliú Nogales
- Cardiology Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - Jesús María González
- Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Rafael Sadaba
- Cardiac Surgery Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - María Ángeles Tena
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Raquel Bellot
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Luis Ríos
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Francisco Portela
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
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23
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Right internal thoracic or radial artery as the second arterial conduit for coronary artery bypass surgery. Curr Opin Cardiol 2019; 34:564-570. [PMID: 31219879 DOI: 10.1097/hco.0000000000000654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To summarize the available evidence on the use of the right internal thoracic artery (RITA) and the radial artery as the second arterial graft in coronary artery bypass surgery. RECENT FINDINGS The current data support the equipoise of the two conduits in terms of clinical and angiographic outcomes. Both RITA and radial artery have better patency than saphenous vein grafts. The use of the RITA carries an increased risk of deep sternal wound infection (DSWI) if the artery is harvested as pedicle. Bilateral internal thoracic artery grafting is more technically demanding than radial artery use and there is a volume-outcome relationship in terms of mortality and incidence of DSWI. The radial artery is preferable over RITA in right-sided or distal circumflex artery targets with high-degree stenosis and in patients at higher risk for DSWI, whereas it is not recommended to graft vessels with moderate stenosis and in cases of insufficient collateralization from the ulnar artery or previous transradial procedures. SUMMARY The patency rate and clinical outcomes of radial artery and RITA are similar. The use of one or the other should be based on a careful evaluation of the patient's coronary anatomy and comorbidities, the conduit availability and the surgeon's and center's experience.
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24
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Pu A, Ding L, Shin J, Price J, Skarsgard P, Wong DR, Bozinovski J, Fradet G, Abel JG. Long-term Outcomes of Multiple Arterial Coronary Artery Bypass Grafting: A Population-Based Study of Patients in British Columbia, Canada. JAMA Cardiol 2019; 2:1187-1196. [PMID: 29049458 DOI: 10.1001/jamacardio.2017.3705] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Although the long-term survival advantage of multiple arterial grafting (MAG) vs the standard use of left internal thoracic artery (LITA) supplemented by saphenous vein grafts (LITA+SVG) has been demonstrated in several observational studies, to our knowledge its safety and other long-term clinical benefits in a large, population-based cohort are unknown. Objective To compare the safety and long-term outcomes of MAG vs LITA+SVG among overall and selected subgroups of patients. Design, Setting, and Participants In this population-based observational study, we included 20 076 adult patients with triple-vessel or left-main disease who underwent primary isolated coronary artery bypass grafting (MAG, n = 5580; LITA+SVG, n = 14 496) in the province of British Columbia, Canada, from January 2000 to December 2014, with follow-up to December 2015. We performed propensity-score analyses by weighting and matching and multivariable Cox regression to minimize treatment selection bias. Exposures Multiple arterial grafting or LITA+SVG. Main Outcomes and Measures Mortality, repeated revascularization, myocardial infarction, heart failure, and stroke. Results Of 5580 participants who underwent MAG, 586 (11%) were women and the mean (SD) age was 60 (8.7) years. Of 14 496 participants who underwent LITA+SVG, 2803 (19%) were women and the mean (SD) age was 68 (8.9) years. The median (interquartile range) follow-up time was 9.1 (5.1-12.6) years and 8.1 (4.5-11.7) years for the groups receiving MAG and LITA+SVG, respectively. Compared with LITA+SVG, MAG was associated with reduced mortality rates (hazard ratio [HR], 0.79; 95% CI, 0.72-0.87) and repeated revascularization rates (HR, 0.74; 95% CI, 0.66-0.84) in 15-year follow-up and reduced incidences of myocardial infarction (HR, 0.63; 95% CI, 0.47-0.85) and heart failure (HR, 0.79; 95% CI, 0.64-0.98) in 7-year follow-up. The long-term benefits were coherent by all 3 statistical methods and persisted among patient subgroups with diabetes, obesity, moderately impaired ejection fraction, chronic obstructive pulmonary disease, peripheral vascular disease, or renal disease. Multiple arterial grafting was not associated with increased morbidity or mortality rates at 30 days overall or within patient subgroups. Conclusions and Relevance Compared with LITA+SVG, MAG is associated with reduced mortality, repeated revascularization, myocardial infarction, and heart failure among patients with multivessel disease who are undergoing coronary artery bypass grafting without increased mortality or other adverse events at 30 days. The long-term benefits consistently observed across multiple outcomes and subgroups support the consideration of MAG for a broader spectrum of patients who are undergoing coronary artery bypass grafting in routine practice.
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Affiliation(s)
- Aihua Pu
- Cardiac Services BC, Vancouver, British Columbia, Canada
| | - Lillian Ding
- Cardiac Services BC, Vancouver, British Columbia, Canada
| | - Jungwon Shin
- Cardiac Services BC, Vancouver, British Columbia, Canada
| | - Joel Price
- Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Skarsgard
- Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel R Wong
- University of British Columbia, Vancouver, British Columbia, Canada.,Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - John Bozinovski
- University of British Columbia, Vancouver, British Columbia, Canada.,Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Guy Fradet
- University of British Columbia, Vancouver, British Columbia, Canada.,Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - James G Abel
- University of British Columbia, Vancouver, British Columbia, Canada.,St. Paul's Hospital, Vancouver, British Columbia, Canada
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25
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Schwann TA, Habib RH, Wallace A, Shahian D, Gaudino M, Kurlansky P, Engoren MC, Tranbaugh RF, Schwann AN, Jacobs JP. Bilateral internal thoracic artery versus radial artery multi-arterial bypass grafting: a report from the STS database†. Eur J Cardiothorac Surg 2019; 56:926-934. [DOI: 10.1093/ejcts/ezz106] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/27/2019] [Accepted: 03/06/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Multi-arterial bypass grafting with bilateral internal thoracic (BITA-MABG) or radial (RA-MABG) arteries improves long-term survival, but its increased complexity raises perioperative safety concerns. We compared perioperative outcomes of RA-MABG and BITA-MABG using the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS-ACSD).
METHODS
We analysed the 2004–2015 BITA-MABG and RA-MABG experience in STS-ACSD. Primary end points were operative mortality (OM) and deep sternal wound infections (DSWI). Risk-adjusted odds ratios [AOR (95% confidence interval)] were derived via multivariable logistic regression. Sensitivity analyses were done in patient sub-cohorts and based on institutional BITA-utilization rates (<5%, 5–10%, 10–20%, 20–40% and >40%).
RESULTS
Eighty-five thousand nine hundred five RA-MABG (82.5% men; 61 years) and 61 336 BITA-MABG (85.1% men; 59 years) patients were analysed; 41.6% of BITA-MABG and 27.3% of RA-MABG cases came from institutions with low MABG utilization rates (<10%). Unadjusted OM was equivalent for both techniques (BITA-MABG versus RA-MABG: 1.3% vs 1.2%, P = 0.79), while DSWI was lower for RA-MABG (1.0% vs 0.6%, P < 0.001). RA-MABG was associated with lower adjusted OM [AOR = 0.80 (0.69–0.96)] and DSWI [AOR = 0.39 (0.32–0.46)]. Sensitivity analyses confirmed robustness of these findings. Equivalent outcomes were observed at high BITA-use institutions where BITA cases comprised >20% of all cases for OM and ≥40% for DSWI.
CONCLUSIONS
This analysis of the STS-ACSD showed that RA-MABG is a generally safer form of multi-arterial coronary artery bypass grafting surgery. However, this advantage is mitigated at institutions with substantial BITA experience.
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Affiliation(s)
- Thomas A Schwann
- Department of Surgery, University of Massachusetts-Baystate, Springfield, MA, USA
- Department of Surgery, University of Toledo, Toledo, OH, USA
| | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, IL, USA
| | - Amelia Wallace
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - David Shahian
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Mario Gaudino
- Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Paul Kurlansky
- Department of Surgery, Columbia University, New York, NY, USA
| | - Milo C Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Jeffrey P Jacobs
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
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26
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Gaudino MFL, Spadaccio C, Taggart DP. State-of-the-Art Coronary Artery Bypass Grafting: Patient Selection, Graft Selection, and Optimizing Outcomes. Interv Cardiol Clin 2019; 8:173-198. [PMID: 30832941 DOI: 10.1016/j.iccl.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite the progressive expansion of clinical indications for percutaneous coronary intervention and the increasingly high risk profile of referred patients, coronary artery bypass grafting (CABG) remains the mainstay in multivessel disease, providing good long-term outcomes with low complication rates. Multiple arterial grafting, especially if associated with anaortic techniques, might provide the best longer-term outcomes. A surgical approach individualized to the patients' clinical and anatomic characteristics, and surgeon and team experience, are key to excellent outcomes. Current evidence regarding patient selection, indications, graft selection, and potential strategies to optimize outcomes in patients treated with CABG is summarized.
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Affiliation(s)
- Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10021, USA.
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow G81 4DY, UK; University of Glasgow, Institute of Cardiovascular and Medical Sciences, 126 University Place, Glasgow G128TA, UK
| | - David P Taggart
- Department of Cardiovascular Surgery, University of Oxford, Headley Way, Oxford, Oxforshire OX39DU, UK; Department Cardiac Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, Oxfordshire OX3 9DU, UK
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27
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Hosono M, Murakami T, Hirai H, Sasaki Y, Suehiro S, Shibata T. The Risk Factor Analysis for the Late Graft Failure of Radial Artery Graft in Coronary Artery Bypass Grafting. Ann Thorac Cardiovasc Surg 2019; 25:32-38. [PMID: 30122739 PMCID: PMC6388303 DOI: 10.5761/atcs.oa.18-00054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective: The aim of this retrospective study was to investigate the early operative results and detect the factors influencing the fate of radial artery grafts (RAGs) by evaluating the mid-term patency. Methods: We retrospectively reviewed 410 patients who underwent isolated coronary artery bypass grafting using RAG. RAGs were anastomosed to 526 coronary arteries. Mid-term angiography was performed in 214 patients at an average 4.9 years after the operation. Results: The early patency of RAGs was 97.6%. Cumulative 5-year patency was 86.5% for RAG, 94.1% for LITA graft, and 81.0% for saphenous vein graft (SVG). RAG was significantly superior to SVG in mid-term patency. Individual grafting (not sequential grafting) (hazard ratio [HR]: 2.535; 95% confidence interval [CI]: 1.293–5.281; p = 0.006) and grafting to the target coronary artery with ≤75% proximal stenosis (HR: 1.947; 95% CI: 1.090–3.484; p = 0.025) were found to be independent risk factors influencing late RAG patency. Conclusions: The patency of RAGs was superior to that of SVGs in the studied population. When using RAGs, grafting to the target vessel with severe proximal stenosis is favorable. The RAG is suitable for sequential grafting.
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Affiliation(s)
- Mitsuharu Hosono
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Takashi Murakami
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Hidekazu Hirai
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Yasuyuki Sasaki
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Shigefumi Suehiro
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
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28
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Cuminetti G, Bonadei I, Vizzardi E, Sciatti E, Lorusso R. On-Pump Coronary Artery Bypass Graft: The State of the Art. Rev Recent Clin Trials 2019; 14:106-115. [PMID: 30836924 DOI: 10.2174/1574887114666190301142114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/21/2017] [Accepted: 12/05/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) remains the standard of care for patients with coronary artery disease (CAD). Debate exists concerning several factors, which include percutaneous coronary intervention (PCI) vs. CABG, single vs. bilateral mammary artery grafts, radial artery vs. saphenous vein grafts, right internal mammary artery vs. radial artery grafts, endoscopic vs. open vein-graft harvesting, and on-pump vs. off- pump surgery. Moreover, challenging is the management of diabetic patients with CAD undergoing CABG. This review reports current indications, practice patterns, and outcomes of CABG. METHODS Randomized controlled trials comparing CABG to other therapeutical strategies for CAD were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. RESULTS Large multicenter randomized and observational studies (SYNTAX, BEST, PRECOMBAT, ASCERT) have reported excellent outcomes in CABG patients, with always fewer rates of operative mortality and major morbidity, than PCI. The 10-year follow-up of ARTS II trial showed no difference between single and bilateral mammary artery. BARI 2D, MASS II, CARDia, FREEDOM trials showed that CABG is the best choice for diabetic patients. CONCLUSION CABG still represents one of the most widespread major surgeries, with well-known benefits on symptoms and prognosis in patients with CAD. However, further studies and follow-up data are needed to validate these evidences.
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Affiliation(s)
- Giovanni Cuminetti
- Cardiology Unit, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - Ivano Bonadei
- Cardiology Unit, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - Enrico Vizzardi
- Cardiology Unit, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - Edoardo Sciatti
- Cardiology Unit, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
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29
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Di Bacco L, Repossini A, Tespili M, Muneretto C, Bisleri G. Long-term follow-up of total arterial versus conventional and hybrid myocardial revascularization: A propensity score matched analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:22-28. [DOI: 10.1016/j.carrev.2018.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 11/25/2022]
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30
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Tatoulis J. The radial artery in coronary surgery, 2018. Indian J Thorac Cardiovasc Surg 2018; 34:234-244. [PMID: 33060944 DOI: 10.1007/s12055-018-0694-3] [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: 04/25/2018] [Accepted: 07/12/2018] [Indexed: 11/30/2022] Open
Abstract
It is now 25 years since the radial artery (RA) was reintroduced in coronary surgery. It has evolved into being a significant coronary artery bypass conduit and ranks third in usage after the internal thoracic artery (ITA) and saphenous vein grafts (SVG). Its advantages are that it can be readily and efficiently harvested, is of good length and appropriate size for coronary artery bypass graft (CABG) surgery, is robust and easy to handle, and remains free of atheroma, and there is minimal wound morbidity. The RA must be used judiciously with attention to spasm prophylaxis because of its muscular wall, and by avoiding competitive flow. Its patency is equivalent to the ITAs when placed to similar coronary territories and under similar conditions (stenosis, size, quality) and RA patencies are always superior to those of SVG in both observational and randomized studies-88-90% versus 50-60% at 10 years, and 80-87% versus 25-40% at 20 years. Its use and excellent patencies result in survival results equivalent to bilateral internal thoracic artery (BITA) grafting and always superior to left internal thoracic artery (LITA) +SVG. Typical radial artery multiarterial bypass grafting (RA-MABG) 10-year survivals are 80-90% versus 70-80% for LITA-SVG. In general, for every 100 patients undergoing CABG, 10 more patients will be alive at 10 years post-operatively. The RA also is important in achieving total arterial revascularization, and several reports indicate a further survival advantage for patients having three arterial grafts over two. The RAs are especially useful in diabetic, morbidly obese patients, those with conduit shortage, and leg pathology, and in coronary reoperations. Although the RA has equivalent patencies to the right internal thoracic artery (RITA), it is much more versatile. RAs that have been instrumented by angiography or percutaneous coronary intervention should be avoided. The radial artery has proved to be an excellent arterial conduit, is equivalent to but more versatile than the RITA, and is always superior to SVG. Its use should be part of every coronary surgeon's skill set.
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Affiliation(s)
- James Tatoulis
- Royal Melbourne Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
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31
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Cormican D, Jayaraman AL, Sheu R, Peterson C, Narasimhan S, Shaefi S, Núñez-Gil IJ, Ramakrishna H. Coronary Artery Bypass Grafting Versus Percutaneous Transcatheter Coronary Interventions: Analysis of Outcomes in Myocardial Revascularization. J Cardiothorac Vasc Anesth 2018; 33:2569-2588. [PMID: 30340948 DOI: 10.1053/j.jvca.2018.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Daniel Cormican
- Division of Cardiothoracic Anesthesiology & Critical Care Medicine, Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | | | - Richard Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Carly Peterson
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Seshasayee Narasimhan
- Department of Cardiology, Manning Base Hospital, Taree, New South Wales, Australia University of Newcastle, Callaghan, New South Wales, Australia; University of New England, Armidale, New South Wales, Australia
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Iván J Núñez-Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clinico Universitario San Carlos, Madrid, Spain; Cardiovascular Unit, Centro Medico Paris, Pozuelo, Madrid, Spain
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ.
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32
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Tatoulis J, Schwann TA. Long term outcomes of radial artery grafting in patients undergoing coronary artery bypass surgery. Ann Cardiothorac Surg 2018; 7:636-643. [PMID: 30505748 DOI: 10.21037/acs.2018.05.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Single arterial left internal thoracic artery (LITA) based coronary artery bypass surgery (LITA-SABG) has been the principal revascularization strategy for over 25 years across all patient demographics. In line with the current emphasis being placed on personalized medicine, which tailors individual, patient-specific therapy to optimize outcomes, coronary artery bypass grafting (CABG) techniques have also evolved to achieve enhanced results among specific groups of patients with coronary artery disease. Most notable has been the development of multi-arterial bypass grafting (MABG) techniques, using either the radial artery (RA) or the right internal thoracic artery (RITA) in conjunction with the LITA, as both techniques have been shown to enhance long term survival of CABG patients. This article reviews the latest data on the long-term outcomes of RA-MABG and considers its impact in various sub-cohorts of CABG that are increasingly being treated by cardiac surgeons. The primary aim of this review is to highlight the advantages of RA-MABG over LITA-SABG and thereby potentiate its adoption into clinical practice. Our secondary aim is to summarize the results of RA-MABG in specific CABG sub-cohorts, to more closely align CABG surgery with the emerging consensus that personalized medicine enhances healthcare value.
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Affiliation(s)
- James Tatoulis
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Thomas A Schwann
- Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
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33
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Affiliation(s)
- Oz M Shapira
- From the Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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34
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Leonard JR, Abouarab AA, Tam DY, Girardi LN, Gaudino MFL, Fremes SE. The radial artery: Results and technical considerations. J Card Surg 2018; 33:213-218. [DOI: 10.1111/jocs.13533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Jeremy R. Leonard
- Department of Cardiothoracic Surgery; Weill Cornell Medicine; New York New York
| | - Ahmed A. Abouarab
- Department of Cardiothoracic Surgery; Weill Cornell Medicine; New York New York
| | - Derrick Y. Tam
- Division of Cardiac Surgery; Schulich Heart Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Leonard N. Girardi
- Department of Cardiothoracic Surgery; Weill Cornell Medicine; New York New York
| | - Mario F. L. Gaudino
- Department of Cardiothoracic Surgery; Weill Cornell Medicine; New York New York
| | - Stephen E. Fremes
- Division of Cardiac Surgery; Schulich Heart Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
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35
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Schwann TA, Gaudino M, Baldawi M, Tranbaugh R, Schwann AN, Habib RH. Optimal management of radial artery grafts in CABG: Patient and target vessel selection and anti-spasm therapy. J Card Surg 2018; 33:205-212. [PMID: 29370589 DOI: 10.1111/jocs.13517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The current literature on radial artery grafting is reviewed focusing on the optimal deployment of radial artery grafts in coronary artery bypass surgery with specific attention to the selection of patients and target vessels for radial artery grafting.
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Affiliation(s)
- Thomas A Schwann
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | | | - Mustafa Baldawi
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | | | | | - Robert H Habib
- Society of Thoracic Surgeons Research Center, Chicago, Illinois
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36
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Coronary Artery Bypass Graft Surgery Using the Radial Artery, Right Internal Thoracic Artery, or Saphenous Vein as the Second Conduit. Ann Thorac Surg 2017; 104:553-559. [DOI: 10.1016/j.athoracsur.2016.11.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 10/03/2016] [Accepted: 11/07/2016] [Indexed: 11/22/2022]
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Schwann TA. The Surgical Treatment of Coronary Artery Occlusive Disease: Modern Treatment Strategies for an Age Old Problem. Surg Clin North Am 2017; 97:835-865. [PMID: 28728719 DOI: 10.1016/j.suc.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Coronary artery disease remains a formidable challenge to clinicians. Percutaneous interventions and surgical techniques for myocardial revascularization continue to improve. Concurrently, in light of emerging data, multiple practice guidelines have been published guiding clinicians in their therapeutic decisions. The multidisciplinary Heart Team concept needs to be embraced by all cardiovascular providers to optimize patient outcomes.
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Affiliation(s)
- Thomas A Schwann
- Department of Surgery, University of Toledo College of Medicine & Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA.
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Right internal thoracic artery or radial artery? A propensity-matched comparison on the second-best arterial conduit. J Thorac Cardiovasc Surg 2016; 153:79-88.e4. [PMID: 27697357 DOI: 10.1016/j.jtcvs.2016.08.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/05/2016] [Accepted: 08/26/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We conducted propensity score matching to determine whether the use of the right internal thoracic artery (RITA) confers a survival advantage when compared with the radial artery (RA) as second arterial conduit in coronary artery bypass grafting. METHODS The study population included a highly selected low-risk group of patients who received the RITA (n = 764) or the RA (n = 1990) as second arterial conduit. We obtained 764 matched pairs that were comparable for all pretreatment variables. A time-segmented Cox regression model that stratified on the matched pairs was used to investigate the effect of treatment on late mortality. RESULTS After a mean follow-up of 10.2 ± 4.5 years (maximum 17.3 years), survival probabilities at 5, 10, and 15 years were 96.4% ± 0.7% versus 95.4% ± 0.7%, 91.0% ± 1.1% versus 89.1% ± 1.2%, and 82.4% ± 1.9% versus 77.2% ± 2.5% in the RITA and RA groups, respectively. During the first 4 years, RITA and RA were comparable in terms of mortality (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.56-1.78; P = .98). However, after 4 years RITA was associated with a significant reduction in late mortality (HR, 0.67; 95% CI, 0.48-0.95; P = .02). RITA was superior to RA when the experimental conduit was used to graft the left coronary system (HR, 0.69; 95% CI, 0.47-0.99; P = .04) but not the right coronary system (HR, 0.98; 95% CI, 0.59-1.62; P = .93). CONCLUSIONS In a highly selected low-risk group of patients, the use of the RITA as second arterial conduit instead of the RA was associated with better survival when used to graft the left but not the right coronary artery.
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Right internal thoracic artery versus radial artery as the second best arterial conduit: Insights from a meta-analysis of propensity-matched data on long-term survival. J Thorac Cardiovasc Surg 2016; 152:1083-1091.e15. [PMID: 27342731 DOI: 10.1016/j.jtcvs.2016.05.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/13/2016] [Accepted: 05/19/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE(S) We conducted a meta-analysis of propensity score-matching (PSM) studies comparing long-term survival of patients receiving right internal thoracic artery (RITA) versus radial artery (RA) as a second arterial conduit for coronary artery bypass grafting. METHODS A literature search was conducted using MEDLINE, EMBASE, and Web of Science to identify relevant articles. Primary endpoint was long-term mortality. Secondary endpoints were operative mortality, incidence of sternal wound infection, and repeat revascularization. Binary events were pooled using the DerSimonian and Laird method. For time-to-event outcomes, estimates of log hazard ratio (HR) and standard errors obtained were combined using the generic inverse-variance method. RESULTS A total of 8 PSM studies were finally selected including 15,374 patients (RITA, 6739; RA, 8635) with 2992 matched pairs for final comparison. Mean follow-up time ranged from 45 to 168 months. When compared with RA, RITA was associated with a lower risk reduction of late death (HR, 0.75; 95% confidence interval [CI], 0.58-0.97; P = .028) and repeat revascularization (HR, 0.37; 95% CI, 0.16-0.85; P = .03). On the other hand, RITA did not increase operative mortality (odds ratio [OR], 1.53; 95% CI, 0.97-2.39; P = .07). RITA was associated with an increased risk of sternal wound complication when pedicled harvesting was used (OR, 3.18; 95% CI, 1.34-7.57), but not with skeletonized harvesting (OR, 1.07; 95% CI, 0.67-1.71). CONCLUSIONS The present PSM data meta-analysis suggests that the use of RITA compared with RA was associated with superior long-term survival and freedom from repeat revascularization, with similar operative mortality and incidence of sternal wound complication when the skeletonized harvesting technique was used.
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Kurlansky P. Multiple arterial grafting for coronary revascularization: "A guide for the perplexed". Trends Cardiovasc Med 2016; 26:616-23. [PMID: 27180277 DOI: 10.1016/j.tcm.2016.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
Abstract
The surgical literature abounds with articles extolling the benefits of arterial grafting for patients with advanced coronary artery disease in need of surgical revascularization. However, examination of clinical performance demonstrates that extensive use of arterial grafting is highly selective and generally uncommon. Rather than to merely repeat multiple excellent recent literature reviews, the goal herein is to provide the reader with a guide to the evaluation of the current literature as well as to suggest fruitful areas for further research. More circumspect understanding of the strengths and weaknesses of our current knowledge base will not only help to explain the current apparent disparity between theory and practice but will hopefully inform future decision-making and patient care.
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Affiliation(s)
- Paul Kurlansky
- Department of Surgery, Columbia University, New York, NY.
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Is a third arterial conduit necessary? Comparison of the radial artery and saphenous vein in patients receiving bilateral internal thoracic arteries for triple vessel coronary disease. Eur J Cardiothorac Surg 2016; 50:53-60. [DOI: 10.1093/ejcts/ezv467] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 12/04/2015] [Indexed: 11/14/2022] Open
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Abstract
Coronary artery bypass grafting is the most common cardiac surgery operation performed worldwide. It is the most effective revascularization method for several categories of patients affected by coronary artery disease. Although coronary artery bypass grafting has been performed for more than 40 years, no detailed guidelines on the choice of coronary artery bypass grafting conduits have been published and the choice of the revascularization strategy remains more a matter of art than of science. Moreover, there is a clear contradiction between the proven benefits of arterial grafting and its very limited use in everyday clinical practice. In the hope of encouraging wider diffusion of arterial revascularization and to provide a guide for clinicians, we discuss current evidence for the use of different conduits in coronary artery bypass surgery and propose an evidence-based algorithm for the choice of the second conduit during coronary artery bypass operations.
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Pevni D, Mohr R, Paz Y, Kramer A, Ben-Gal Y, Nesher N, Medalion B. Long-term outcome of revascularization with composite T-grafts: Is bilateral mammary grafting better than single mammary and radial artery grafting? J Thorac Cardiovasc Surg 2015; 151:1311-9. [PMID: 26794927 DOI: 10.1016/j.jtcvs.2015.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 11/20/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Bilateral internal mammary artery (BIMA) grafting is associated with improved survival. However, many surgeons are reluctant to use this technique, owing to the potentially increased risk of sternal infection. The composite T-graft with radial artery (RA) attached end-to-side to the left internal mammary artery (IMA) provides complete arterial revascularization without increased risk of sternal infection. The purpose of this study is to compare outcomes of these 2 strategies. METHODS Patients who underwent BIMA grafting using the composite T-graft technique, between 1996 and 2010 (n = 1329), were compared with 389 patients who underwent composite grafting with a single IMA + RA during the same time period. RESULTS Patients undergoing single IMA grafting were older, more often women, and more likely to have diabetes, peripheral vascular disease, and COPD, and to need an emergency operation. Congestive heart failure, left main disease, and recent myocardial infarction were more prevalent with bilateral grafting. Propensity-score matching was used to account for differences between groups in preoperative patient characteristics. The 268 matched pairs had similar characteristics. The median follow-up time was 14.19 (95% confidence interval 13.43-14.95) years. Operative mortality and Kaplan-Meier 10-year survival of the 2 matched groups were similar (3.4% vs 3.7%, and 61.6% vs 64%, for the groups treated with BIMA and single IMA, respectively). Cox-adjusted survival was similar (P = .514). Age, chronic renal failure, and performance of <3 bypass grafts were independent predictors of decreased survival. CONCLUSIONS This study suggests that long-term outcomes of arterial revascularization with a composite T-graft constructed using left IMA and RA are not inferior to outcomes after BIMA grafting.
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Affiliation(s)
- Dmitry Pevni
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel
| | - Rephael Mohr
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel.
| | - Yosef Paz
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel
| | - Amir Kramer
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel
| | - Yanai Ben-Gal
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel
| | - Nahum Nesher
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel
| | - Benjamin Medalion
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Tel Aviv, Israel
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Hayashi Y, Ito T, Maekawa A, Sawaki S, Tokoro M, Yanagisawa J, Murotani K. Effect of modified proximal anastomosis of the free right internal thoracic artery: piggyback and foldback techniques. Interact Cardiovasc Thorac Surg 2015; 22:265-72. [PMID: 26657002 DOI: 10.1093/icvts/ivv333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/24/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Few studies have reported the free right internal thoracic artery (RITA) being used in an aorto-coronary fashion. This study aimed to evaluate the free RITA with modified proximal anastomosis in an aorto-coronary fashion. METHODS Between January 2000 and December 2012, 282 patients underwent coronary artery bypass grafting with bilateral internal thoracic arteries for complete revascularization of the left coronary system at our institution. The left internal thoracic artery (LITA) was anastomosed to the left anterior descending artery (LAD) and the RITA was anastomosed to the left circumflex branches (LCX). The RITA was used as a free graft in 213 patients (free group) and as an in situ graft in 69 patients (in situ group). Proximal anastomosis of the free RITA onto the ascending aorta was performed in two different ways. We compared early and late results and graft patency of the free RITA with those of the in situ RITA retrospectively. RESULTS The numbers of anastomoses per patient and anastomoses of the RITA were larger in the free group than in the in situ group (P < 0.01). There was no significant difference in postoperative survival between the groups (free group: 93.3% vs in situ group: 90.0%, P = 0.82). The 5-year patency of the free RITA was higher than that of the in situ RITA (97.0 vs 80.3%, P = 0.01). The 5-year patency of the free RITA was comparable with that of the in situ LITA anastomosed to the LAD (97.0 vs 92.9%, P = 0.28). CONCLUSIONS The free RITA anastomosed to the LCX might have better late patency than the in situ RITA. The free RITA with modified proximal anastomosis in an aorto-coronary fashion enables complete revascularization of the left coronary system with the in situ LITA to the LAD.
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Affiliation(s)
- Yasunari Hayashi
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan
| | - Atsuo Maekawa
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan
| | - Sadanari Sawaki
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan
| | - Masayoshi Tokoro
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan
| | - Junji Yanagisawa
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan
| | - Kenta Murotani
- Clinical Study Support Center, Aichi Medical University Hospital, Yazakokarimata, Nagakute, Aichi, Japan
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Aldea GS, Bakaeen FG, Pal J, Fremes S, Head SJ, Sabik J, Rosengart T, Kappetein AP, Thourani VH, Firestone S, Mitchell JD. The Society of Thoracic Surgeons Clinical Practice Guidelines on Arterial Conduits for Coronary Artery Bypass Grafting. Ann Thorac Surg 2015; 101:801-9. [PMID: 26680310 DOI: 10.1016/j.athoracsur.2015.09.100] [Citation(s) in RCA: 250] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 12/16/2022]
Abstract
Internal thoracic arteries (ITAs) should be used to bypass the left anterior descending (LAD) artery when bypass of the LAD is indicated (class of recommendation [COR] I, level of evidence [LOE] B). As an adjunct to left internal thoracic artery (LITA), a second arterial graft (right ITA or radial artery [RA]) should be considered in appropriate patients (COR IIa, LOE B). Use of bilateral ITAs (BITAs) should be considered in patients who do not have an excessive risk of sternal complications (COR IIa, LOE B). To reduce the risk of sternal infection with BITA, skeletonized grafts should be considered (COR IIa, LOE B), smoking cessation is recommended (COR I, LOE C), glycemic control should be considered (COR IIa, LOE B), and enhanced sternal stabilization may be considered (COR IIb, LOE C). As an adjunct to LITA to LAD (or in patients with inadequate LITA grafts), use of a RA graft is reasonable when grafting coronary targets with severe stenoses (COR IIa, LOE: B). When RA grafts are used, it is reasonable to use pharmacologic agents to reduce acute intraoperative and perioperative spasm (COR IIa, LOE C). The right gastroepiploic artery may be considered in patients with poor conduit options or as an adjunct to more complete arterial revascularization (COR IIb, LOE B). Use of arterial grafts (specific targets, number, and type) should be a part of the discussion of the heart team in determining the optimal approach for each patient (COR I, LOE C).
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Affiliation(s)
- Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Washington.
| | - Faisal G Bakaeen
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
| | - Jay Pal
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Stephen Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Joseph Sabik
- Center of Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Todd Rosengart
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
| | - A Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Vinod H Thourani
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | | | - John D Mitchell
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
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Multiple arterial bypass grafting should be routine. J Thorac Cardiovasc Surg 2015; 150:1537-44; discussion 1544-5. [DOI: 10.1016/j.jtcvs.2015.08.075] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 08/14/2015] [Accepted: 08/22/2015] [Indexed: 11/24/2022]
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Tatoulis J, Wynne R, Skillington PD, Buxton BF. Total Arterial Revascularization: Achievable and Prognostically Effective—A Multicenter Analysis. Ann Thorac Surg 2015; 100:1268-75; discussion 1275. [DOI: 10.1016/j.athoracsur.2015.03.107] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/25/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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Dahal K, Rijal J, Lee J, Korr KS, Azrin M. Transulnar versus transradial access for coronary angiography or percutaneous coronary intervention: A meta-analysis of randomized controlled trials. Catheter Cardiovasc Interv 2015; 87:857-65. [DOI: 10.1002/ccd.26221] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/09/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Khagendra Dahal
- Department of Medicine; LRGHealthcare; Laconia New Hampshire
| | - Jharendra Rijal
- Department of Medicine; Miriam Hospital, Alpert Medical School of Brown University; Providence Rhode Island
| | - Juyong Lee
- Division of Cardiology; Calhoun Cardiology Center, University of Connecticut Health Center; Farmington Connecticut
| | - Kenneth S. Korr
- Division of Cardiology; Miriam Hospital, Alpert Medical School of Brown University Providence; Rhode Island
| | - Michael Azrin
- Division of Cardiology; Calhoun Cardiology Center, University of Connecticut Health Center; Farmington Connecticut
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Guyton RA. Multiple Arterial Coronary Bypass Grafting. J Am Coll Cardiol 2015; 66:1428-30. [DOI: 10.1016/j.jacc.2015.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
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Kinoshita T, Asai T, Suzuki T. Off-pump bilateral skeletonized internal thoracic artery grafting in patients with chronic kidney disease. J Thorac Cardiovasc Surg 2015; 150:315-21.e3. [DOI: 10.1016/j.jtcvs.2015.04.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/07/2015] [Accepted: 04/18/2015] [Indexed: 11/30/2022]
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