Better ischemic event-free survival after two internal thoracic artery grafts: 13 years of follow-up

Berreklouw, Eric; Rademakers, Phillip P.C; Koster, Jurgen M; Leur, Linda van; Wielen, Brigitte J.W van der; Westers, Paul

doi:10.1016/s0003-4975(01)03040-5

Cited by 71 publications

(54 citation statements)

References 12 publications

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“…[5][6][7][8]10 Although Rankin and colleagues 8 showed a clear principle of patient allocation, with patients allocated prospectively to 2 faculty surgeons with different preferences, the treatment choices were at the discretion of the attending surgeon in the other 4 studies. [5][6][7]10 Four studies had no information on losses to follow-up. 6,8,10,11 Three studies had >1000 patients in both the SIMA and BIMA groups.…”

Section: Resultsmentioning

confidence: 99%

“…A significant reduction in mortality by using BIMA was observed by meta-analysis (hazard ratio, 0.79; 95% CI, 0.75-0.84; Figure 2). A subgroup analysis considered studies using different statistical approaches: statistically unmatched, [3][4][5]8 quintile-based propensity score analysis, 7,9,11 and propensity score-based exact patient matching. 6,10 All 3 subgroups showed a survival benefit of BIMA grafting with hazard ratios of 0.81 (95% CI, 0.69-0.94) in the statistically unmatched group, 0.81 (95% CI, 0.75-0.87) in the quintile-based propensity score analysis group, and 0.75 (95% CI, 0.65-0.85) in the propensity score-based exact matching group.…”

Section: 11mentioning

confidence: 99%

“…1 Since then, the potential benefits of bilateral internal mammary artery (BIMA) grafting over single internal mammary artery (SIMA) grafting on survival and cardiac-related events have been emphasized by many investigators. [2][3][4][5][6][7][8][9][10][11] In 2001, our group published a systematic review including a meta-analysis with 15 962 patients with the BIMA group showing a significant reduction in mortality (hazard ratio, 0·81; 95% confidence interval [CI], 0.70-0.94) after a median of 4 years of follow-up with no study showing significantly harmful effect of BIMA grafts. 2 This benefit is likely to be a consequence of documented patency rates of ≥90% for BIMA grafts into the third decade of follow-up in contrast to vein grafts of which three-quarters are occluded or severely diseased by 10 years of follow-up.…”

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Effect of Bilateral Internal Mammary Artery Grafts on Long-Term Survival

et al. 2014

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Background-Although the potential survival benefit of bilateral internal mammary artery (BIMA) grafting in comparison with single internal mammary artery (SIMA) grafting has been emphasized by many investigators, the use of BIMA is still low in clinical practice in the absence of randomized trials and long-term results. In the current study, we aimed to assess if there is a long-term survival benefit of BIMA up to 10 years after coronary bypass surgery. Methods and Results-We selected published articles comparing survival between SIMA and BIMA patients with follow-up duration of more than a mean of 9 years. We evaluated the log hazard ratio with 95% confidence interval for included studies by using a random-effects meta-analysis. Nine eligible observational studies provided 15 583 patients (8270 SIMA and 7313 BIMA) for meta-analysis. Five studies used propensity score methods for statistical adjustment, 2 with a propensity score-based patient-matching method and 3 with quintile-based stratification. A significant reduction in mortality by using BIMA was observed (hazard ratio, 0.79; 95% confidence interval, 0.75-0.84); no study showed any significantly harmful effect of BIMA on survival. Subgroups of studies using different statistical approaches-unmatched, quintile-based propensity score analysis, and propensity score-based exact patient matching-all showed the survival benefit of BIMA grafting. Conclusions-BIMA grafting appears to have better survival with up to 10 years follow-up in comparison with SIMA grafting. Long-term survival benefit of BIMA seems to continue in the second decade after surgery. An ongoing randomized trial comparing SIMA and BIMA groups will add evidence on this issue. The words used for search included "internal mammary (internal thoracic)," "single," "unilateral," "multiple," "bilateral," "artery,", and their combinations using the term "AND." In addition, we searched reference lists of relevant studies, review articles, and meeting abstracts. We included published articles satisfying the following criteria: (1) survival comparison of single and bilateral IMA grafting; (2) long-term results with more than a mean of 9 years of followup; and (3) minimum 100 patients in each group. If any institution reported ≥2 reports on this issue, the latest one was included. Studies were excluded unless the comparability of patient characteristics was controlled either by design or analysis, at least for age, sex, ventricular function, and diabetes mellitus. Only articles published in English were included. All data were extracted independently by 2 reviewers (G.Y. and D.T.). If there were any discrepancies, they were resolved by consensus meeting. In studies where hazard ratios were not given directly, we calculated them by using a spreadsheet method for extracting data from published literature provided by Tierney and colleagues. 17 The primary outcome measurement was death from any cause. Quality Assessment of Selected StudiesFor the quality assessment of studies, we used the same criteria as in o...

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Section: Resultsmentioning

confidence: 99%

Section: 11mentioning

confidence: 99%

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confidence: 99%

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Effect of Bilateral Internal Mammary Artery Grafts on Long-Term Survival

et al. 2014

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“…However, improvement in quality of life had previously been demonstrated in elderly patients receiving arterial grafts CABG. 34) Berreklouw and colleagues 35) reported that 47.5% of patients with BITA grafts versus 35.4% of patients with SITA grafts had an ischemic event-free existence after 13 years (P < 0.001). Muneretto, et al, 36) in a prospective randomized group of 188 patients older than 70 years randomized to either total arterial grafting or SITA grafting, found that recurrent angina occurred in 11.1% of the SITA/vein group versus 2.1% of the total arterial group.…”

Section: Bilateral Internal Thoracic Artery Revascularization In the mentioning

confidence: 99%

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

Nicolini

Vezzani²,

Romano

et al. 2017

Int. Heart J.

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SummaryAlthough improved long-term outcomes obtained with the use of arterial grafts for coronary revascularization in comparison with the traditional association of a single arterial and saphenous vein grafts have been demonstrated in the overall population, the efficacy of this newer technique in the elderly is difficult to prove because their shorter life expectancy due to advanced heart disease, associated with severe comorbidities. Moreover, more widespread use of this technique is limited by the concerns on the potential morbidity, particularly the longer time required to perform the operation and the possibility of deep sternal wound infection in case of bilateral internal thoracic artery harvesting due to the decreased blood supply to the sternum and surrounding tissues.The review of the recent literature indicates that the use of bilateral internal thoracic arteries in very elderly patients should not be considered routinely. It seems reasonable to avoid it in octogenarians in the presence of well-known predictors of sternal complications such as diabetes, morbid obesity, and severe chronic lung disease.There is also still controversy about the superiority of the radial artery over the saphenous vein graft as a second or third conduit for surgical myocardial revascularization, although the majority of recent studies seem to support more liberal use of the radial artery as second arterial conduit in the elderly. Although a clinical benefit of arterial graft revascularization cannot be formally excluded for elderly patients, the increased complexity of this technique suggests that careful clinical judgment is necessary to select grafts for individual patients.(Int Heart J 2017; 58: 647-653) Key words: Coronary artery disease, Old patients, Arterial grafts N owadays a growing number of patients are older at the time of coronary artery bypass grafting (CABG) and present with a clinical history characterized by more comorbidities than in the past. However, despite the increasing proportions of elderly patients with a worse risk profile for elective CABG, mortality in elderly patients over recent decades has dramatically declined.1) In fact, recent studies on elderly patients operated with CABG reported a 30-day mortality rate ranging between 3.7 and 16.8%, a 1-year mortality between 8% and 10.8% and a 5-year mortality ranging from 28.4% to 31%. 2-6)It is well recognized that octogenarians have a higher risk of post-operative complications, 7) require greater clinical and economic resources, and have worse but acceptable short and long-term survival in comparison with younger patients. However, improvements in technical management, particularly the development of innovative extracorporeal circulatory systems, the use of off-pump CABG and the increased use of pedicled arterial conduits have been proven effective in improving outcomes, although they have not completely eliminated the morbidity in this high-risk population. [8][9][10][11][12][13][14] Although improved long-term outcomes obtained with the use of ...

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“…[3][4][5] In any patient category, bilateral ITA use has been reported as better than only LITA use in late clinical results. [25][26][27] However, bilateral ITA harvesting has shown a higher incidence of sternal wound infection in patients taking insulin or steroids, who are obesity or have chronic obstructive lung disease. 28,29 In addition, the RITA to LAD graft crossing the midline of the chest may obstruct future reoperations for aortic valve surgery, but to avoid this situation the RITA is unable to reach the posterolateral coronary artery even if it passes through the transverse sinus.…”

Section: Advantage Of Ra Usementioning

confidence: 99%

Radial Artery as a Graft for Coronary Artery Bypass Grafting

Kobayashi

2009

Circ J

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Better ischemic event-free survival after two internal thoracic artery grafts: 13 years of follow-up

Cited by 71 publications

References 12 publications

Effect of Bilateral Internal Mammary Artery Grafts on Long-Term Survival

Effect of Bilateral Internal Mammary Artery Grafts on Long-Term Survival

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

Radial Artery as a Graft for Coronary Artery Bypass Grafting

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