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Dimagli A, Gemelli M, Kumar N, Mitra M, Sinha S, Fudulu D, Harik L, Cancelli G, Soletti G, Olaria RP, Bonaros N, Gaudino M, Angelini GD. A systematic review and meta-analysis of internal thoracic artery harvesting techniques: Skeletonized vs pedicled. Int J Cardiol 2024; 395:131577. [PMID: 37956758 DOI: 10.1016/j.ijcard.2023.131577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/14/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES The aim of this meta-analysis was to compare clinical and angiographic outcomes of skeletonized versus pedicled internal thoracic artery for coronary artery bypass grafting. METHODS A comprehensive search on Ovid MEDLINE, Ovid EMBASE and Scopus was performed from inception to December 2022. The primary outcome was follow-up mortality and graft failure. Secondary outcomes were repeat revascularization, cardiovascular death and operative mortality, myocardial infarction, stroke, and sternal wound complications (SWCs). Pooled estimate for follow-up outcomes was summarized as incidence rate ratio (IRR) and 95% confidence interval (CI) while short-term outcomes were pooled as odds ratio (OR) and 95% CI. For all outcomes, inverse variance weighting was used for pooling. RESULTS Twenty-eight studies, including 7 randomized trials and 21 observational studies, for a total of 5664 patients in the skeletonized group and 7434 in the pedicled group, were included in the analysis. At a mean weighted follow-up of 4.8 years, there was no difference in mortality between the two groups (IRR 1.14; 95% CI 0.59-2.20). However, the skeletonized group had a higher incidence of graft failure compared to the pedicled group (IRR 1.87, 95% CI 1.33-2.63) but a lower risk of SWCs (OR 0.42; 95% CI 0.30-0.60). There was no difference in short-term outcomes. CONCLUSIONS Compared to the pedicled harvesting technique, skeletonization of the internal thoracic artery is associated with higher rate of graft failure and lower risk of SWCs without mortality difference.
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Affiliation(s)
- Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA; Bristol Heart Institute, University of Bristol, Bristol, UK.
| | - Marco Gemelli
- Bristol Heart Institute, University of Bristol, Bristol, UK; Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular, and Public Health Sciences, University of Padua, Padova, Italy
| | - Niraj Kumar
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Matthias Mitra
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Daniel Fudulu
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Giovanni Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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Kitamura H, Tamaki M, Kawaguchi Y, Okawa Y. Results of off-pump coronary artery bypass grafting with off-pump first strategy in octogenarian. J Card Surg 2021; 36:4611-4616. [PMID: 34613636 PMCID: PMC9291825 DOI: 10.1111/jocs.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
Background and Aim Ischemic heart disease is the leading cause of death around the world. Coronary artery bypass grafting offers efficient surgical revascularization for ischemic disease. Both on‐ or off‐pump coronary artery bypass methods provide promising results to octogenarians, once complete vascularization is achieved. However, off‐pump bypass requires a certain level of experience to achieve sufficient results. We have applied an off‐pump coronary artery bypass‐first strategy to all generations since 2008. This study investigated early and long‐term results of surgical revascularization for octogenarians by a team with an off‐pump‐first strategy. Methods All cases of isolated coronary artery bypass grafting performed since 2008 were identified and divided into a young group (age < 80 years) and an old group (age ≥ 80 years). Peri‐operative results were investigated retrospectively in both groups and long‐term results for the old group were assessed. Results Among the 707 patients, 97% underwent off‐pump bypass, and 94 cases were classified to the old group. Distal anastomoses and ventilator time were identical between groups (young vs. old: 3.3 vs. 3.2; 3.7 h vs. 3.7 h). In‐hospital death rates were 0.5% and 0% in the young and old groups, respectively. With a mean follow‐up of 1318 days, actual 1‐, 3‐, and 5‐year survival rates for octogenarians were 92.1%, 81.2%, and 68.3%, respectively. Nearly half of the patients reached their nineties, which was close to the life expectancy of the national general octogenarian. Conclusions An experienced team with an off‐pump‐first strategy could provide valid therapeutic options for octogenarians.
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Affiliation(s)
- Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhiko Kawaguchi
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
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Vo TX, Rubens FD. Commentary: The Fog of War - The Impact of Missing Data in Database Analyses. Semin Thorac Cardiovasc Surg 2020; 33:395-396. [PMID: 33181290 DOI: 10.1053/j.semtcvs.2020.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Thin X Vo
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Fraser D Rubens
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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