21-Year Survival of Left Internal Mammary Artery–Radial Artery–Y Graft

Royse, Alistair; Brennan, A.; Ou-Young, Jared; Pawanis, Zulfayandi; Canty, David; Royse, Colin

doi:10.1016/j.jacc.2018.06.064

Cited by 47 publications

(33 citation statements)

References 15 publications

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“…Studies were excluded for the following reasons: no comparison between TAR and non‐TAR strategy (n = 32), sample population derived from a previously published and included series (n = 1), and lack of propensity score matching (n = 1). Consequently, 18 articles were included in our study . Mean age and mean body mass index of the included populations were 65.6 years (±7.6) and 27.1 (±1.7).…”

Section: Resultsmentioning

confidence: 99%

“…Dividing the total number of arterial conduits used in the TAR group by the sample population, a number between 2.00 and 2.49 was obtained in five studies . The number of arterial conduits per patient in these five studies were: Bisleri 2016 = 2.42, Grieshaber = 2.04, Navia = 2.00, Royse = 2.00, and Tatoulis = 2.00). These studies were assigned to the group “two arteries in TAR”.…”

Section: Resultsmentioning

confidence: 99%

“…Consequently, 18 articles were included in our study. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Mean age and mean body mass index of the included populations were 65.6 years (±7.6) and 27.1 (±1.7). Thirty percent of the population presented with diabetes and 18.9% were female patients (Table S1).…”

Section: Resultsmentioning

confidence: 99%

“…For this reason, they were assigned to the category "TAR with BIMA". 16,17,[21][22][23][25][26][27]30,31 The remaining 4 studies were categorized as "TAR without BIMA" 19,20,29,32 (Figure 1). The percentages of patients of the TAR group receiving BIMA in these four studies were: Buxton 2012 = 16% 19 ; Buxton 2014 = 36% 20 ; Royse = 0% 29 ; and Tatoulis = 22%.…”

Section: Resultsmentioning

confidence: 99%

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Total arterial revascularization strategies: A meta‐analysis of propensity score‐matched observational studies

et al. 2019

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Background and Aim of the Study We explored the current evidence available on total arterial revascularization (TAR) carrying out a meta‐analysis of propensity score‐matched studies comparing TAR versus non‐TAR strategy. Methods PubMed, EMBASE, and Google Scholar were searched for propensity score‐matched studies comparing TAR vs non‐TAR. The generic inverse variance method was used to compute the combined hazard ratio (HR) of long‐term mortality. The Der‐Simonian and Laird method were used to compute the combined risk ratio (RR) of 30‐day mortality, deep sternal wound infection, and reoperation for bleeding. Results Eighteen TAR vs non‐TAR matched populations were included. Meta‐analysis showed a significant benefit in terms of long‐term survival of the TAR group over the non‐TAR group (HR: 0.73; 95% confidence interval [CI]: 0.68‐0.78). Better long‐term survival over non‐TAR strategy was confirmed by both subgroups: TAR with the bilateral internal mammary artery (BIMA) and TAR without BIMA. Meta‐regression suggests that TAR may offer a higher protective survival effect in diabetic patients (coefficient: −0.0063; 95% CI: −0.01 to 0.0006), when carried out with BIMA (coefficient: −0.15; 95% CI: −0.27 to −0.03) or using three arterial conduits (coefficient: −0.12; 95% CI: −0.25 to 0.007). A TAR strategy carried out using BIMA, differently from TAR without BIMA, increases the risk of deep sternal infection (RR: 1.44; 95% CI: 1.17‐1.77). Conclusions TAR provides a long‐term survival benefit compared with the non‐TAR strategy. Also, compared with TAR without BIMA, TAR with BIMA may offer a higher protective long‐term survival effect at the expense of a higher risk of sternal deep wound infection.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Total arterial revascularization strategies: A meta‐analysis of propensity score‐matched observational studies

et al. 2019

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“…In a large institutional cohort, we demonstrated that the survival of RAY and TAR by other techniques was not different (P = 1.000 [37] , Figure 3).…”

Section: Could Ray and Tar Achieved By Any Other Reconstruction Technmentioning

confidence: 89%

Why and how to achieve total arterial revascularisation in coronary surgery

Royse¹,

Royse²,

Boggett³

et al. 2020

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Single internal mammary artery and supplementary saphenous vein grafts (SVG) continues to be used in approximately 95% of coronary surgery as of 2019. The late failure of SVG is very well documented yet remains the predominant conduit used-why? The left internal mammary artery almost never fails, and late angiography of patent radial artery grafts also appear entirely normal. Logic would suggest that avoiding the conduit known to progressively fail would lead to improved late outcome. Our studies have demonstrated such findings in large single centre and national registry datasets. We describe strategies to achievement of total arterial coronary revascularisation.

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Long-term Outcomes Associated With Total Arterial Revascularization vs Non–Total Arterial Revascularization

et al. 2020

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IMPORTANCEThe optimal conduits for coronary artery bypass grafting (CABG) remain controversial in multivessel coronary artery disease.OBJECTIVE To compare the long-term clinical outcomes of total arterial revascularization (TAR) vs non-TAR (CABG with at least 1 arterial and 1 saphenous vein graft) in a multicenter population-based study. DESIGN, SETTING, AND PARTICIPANTSThis multicenter population-based cohort study using propensity score matching took place from October 2008 to March 2017 in Ontario, Canada, with a mean and maximum follow-up of 4.6 and 9.0 years, respectively. Individuals with primary isolated CABG were identified, with at least 1 arterial graft. Exclusion criteria were individuals from out of province and younger than 18 years. Patients undergoing a cardiac reoperation or those in cardiogenic shock were also excluded because these conditions would potentially bias the surgeon toward not performing TAR. Analysis began April 2019. EXPOSURES Total arterial revascularization.MAIN OUTCOMES AND MEASURES Primary outcome was time to first event of a composite of death, myocardial infarction, stroke, or repeated revascularization (major adverse cardiac and cerebrovascular events). Secondary outcomes included the individual components of the primary outcome. RESULTSOf 49 404 individuals with primary isolated CABG, 2433 (4.9%) received TAR, with the total number of bypasses being 2, 3, and 4 or more vessels in 1521 (62.5%), 865 (35.6%), and 47 individuals (1.9%), respectively. The mean (SD) age was 61.2 (10.4) years and 1983 (81.5%) were men. After propensity score matching, 2132 patient pairs were formed, with equal total number of bypasses (mean [SD], 2.4 [0.5]) but with more arterial grafts in the TAR group (mean [SD], 2.4 [0.5] vs 1.2 [0.4]; P < .01). In-hospital death (15 [0.7%] vs 21 [1.0%]; P = .32) did not differ between TAR vs non-TAR groups after propensity score matching. Throughout 8 years, TAR was associated with improved freedom from major adverse cardiac and cerebrovascular events (hazard ratio, 0.78; 95% CI, 0.68-0.89), death (hazard ratio, 0.80; 95% CI, 0.66-0.97), and myocardial infarction (hazard ratio, 0.69; 95% CI, 0.51-0.92). There was no difference in stroke and repeated revascularization.CONCLUSIONS AND RELEVANCE Total arterial revascularization was associated with improved long-term freedom from major adverse cardiac and cerebrovascular events, death, and myocardial infarction and may be the procedure of choice for patients with reasonable life expectancy requiring CABG.

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21-Year Survival of Left Internal Mammary Artery–Radial Artery–Y Graft

Abstract: Use of LIMA + SVG has worse survival than LIMA-RA-Y in achieving total arterial revascularization.

Cited by 47 publications

References 15 publications

Total arterial revascularization strategies: A meta‐analysis of propensity score‐matched observational studies

Total arterial revascularization strategies: A meta‐analysis of propensity score‐matched observational studies

Why and how to achieve total arterial revascularisation in coronary surgery

Long-term Outcomes Associated With Total Arterial Revascularization vs Non–Total Arterial Revascularization

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