Bilateral Internal Thoracic Artery Grafting: Is It Reasonable in Octogenarians?

Hashimoto, Makoto; Fukui, Toshihiro; Takanashi, Shuichiro

doi:10.5761/atcs.oa.14-00305

Cited by 11 publications

(6 citation statements)

References 24 publications

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“…1-4 However, excellent surgical outcomes have been reported recently, even in the very old. 5, 6 Adequate graft selection for patients aimed at improving late outcomes has assumed increased importance in this era of modern cardiovascular surgery. Usefulness of bilateral internal mammary artery (BIMA) grafting has been reported by many investigators, 7-10 and BIMA grafting has become a standard strategy for patients undergoing surgical coronary revascularization for multivessel disease.…”

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confidence: 99%

Is Bilateral Internal Mammary Arterial Grafting Beneficial for Patients Aged 75 Years or Older?

Itoh

Kimura

Adachi

et al. 2016

Circ J

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Background: Although bilateral internal mammary artery (BIMA) grafting is performed with increasing regularity in elderly patients, whether it is truly beneficial, and therefore indicated, in these patients remains uncertain. We retrospectively investigated early and late outcomes of BIMA grafting in patients aged ≥75 years. Methods and Results:We identified 460 patients aged ≥75 years from among 2,618 patients who underwent either single internal mammary artery (SIMA) grafting (n=293) or BIMA grafting (n=107). Early outcomes did not differ between the SIMA and BIMA patients (30-day mortality: 1.7% vs. 0%, P=0.39; sternal wound infection: 1.0% vs. 4.7%; P=0.057). Late outcomes, 10-year survival in particular, were improved in the BIMA group (36.6% vs. 48.1%, P=0.033). In the analysis of the results in propensity score-matched groups (196 patients in the SIMA group, 98 patients in the BIMA group), improved 10-year survival was documented in the BIMA group (34.8% vs. 47.6%, P=0.030). Cox proportional regression analysis showed SIMA usage (non-use of BIMA) to be a predictor for late mortality (hazard ratio: 0.65, 95% confidence interval: 0.43-0.98, P=0.042). We further compared outcomes between the total non-elderly patients (n=2,158) and total elderly patients (n=460). BIMA usage was similar, as was 30-day mortality (1.0% vs. 1.3%, respectively). Conclusions:A survival advantage, with no increase in early mortality, can be expected from BIMA grafting in patients aged ≥75 years. (Circ J 2016; 80: 1756 -1763

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confidence: 99%

Is Bilateral Internal Mammary Arterial Grafting Beneficial for Patients Aged 75 Years or Older?

Itoh

Kimura

Adachi

et al. 2016

Circ J

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“…It was beneficial to both the healing of sternal wound and venous reflux [14]. Therefore, in BIMA grafting, a number of guidelines have explicitly recommended the use of the skeletonization technique to harvest the IMA to reduce the incidence rate of sternal wound complications [15, 16]. Harvesting of the IMA using the skeletonization technique required precision and strictly abided by the principle of ‘no touch,’ paying careful attention to avoid arterial spasm and endothelial injury, as it was close to the main trunk of the IMA.…”

Section: Discussionmentioning

confidence: 99%

Short-term results of bilateral internal mammary arterial grafting for patients aged 60–75 years – a retrospective study

Guo

Wang

et al. 2019

J Cardiothorac Surg

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Background Bilateral internal mammary artery (BIMA) grafting has a good long-term survival rate and graft patency rate, but it is only recommended in young patients due to its high technical requirements and high incidence of sternal complications. Previous studies indicated that BIMA grafting has a significant benefit in patients aged 50–59 years, but this benefit does not extend to patients aged > 60 years. Thus, this study was designed to analyse the immediate artery graft function, short-term (3 months) results, and experience in preventing sternal complications for BIMA grafting in elderly patients (60–75 years old). Methods Clinical records and echocardiographic and coronary artery computed tomography angiography data of 155 patients who underwent BIMA grafting for coronary artery disease between 2015 and 2017 in our hospital were analysed retrospectively to summarise the operative experience and short-term (3 months) results. Patients were divided into two groups: Group A (n = 95), aged < 60 years and Group B (n = 60), aged 60–75 years. The operation time, aortic clamp time, and cardiopulmonary bypass time of these two groups were compared to analyse the operation difficulty and the flow and pulsatility index were compared to analyse the immediate artery graft function. The left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) of these two groups were compared to analyse heart function. Results There were no significant differences in the operation time, aortic clamp time, and cardiopulmonary bypass time as well as the flow and pulsatility index between these two groups (P > 0.05). There was no significant difference in the incidence of sternal wound complications, graft occlusion, and other common complications 3 months post-BIMA grafting between these two groups (P > 0.05). Furthermore, there was no significant difference in LVEDD and LVEF between the groups 3 months post-operation (P > 0.05). Conclusions BIMA grafting was safe and effective for older patients (60–75 years). Similar to younger patients (< 60 years), BIMA grafting in elderly patients (60–75 years) can also achieve a satisfactory short-term (3 months) result. Thus, advanced age (60–75 years) should not be a contraindication for BIMA grafting.

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“…There is much evidence available in the literature that the long-term outcome of BITA grafts is better than that of pure venous grafts and even better than SITA combine with saphenous vein grafts in the general population as well as in diabetic patients [ [4] , [5] , [6] , [7] , [8] , [9] , [10] ]. The benefits of BITA grafting are also evident in high-risk patients compare to SITA grafting, such as patients with low EF, female, recent myocardial infarction, emergency surgeries, obese, old age, end-stage renal disease (ESRD), on hemodialysis, with PVD, and patients with COPD [ [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ].…”

Section: Comparison Of Bita Vs Sita Grafting From Dswi Perspective In Diabetic Patientsmentioning

confidence: 99%

Effect of bilateral internal thoracic artery harvesting on deep sternal wound infection in diabetic patients: Review of literature

Masroor

Khan

et al. 2021

Annals of Medicine &Amp; Surgery

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Instead of its documented superiority of patency and long-term outcomes, the bilateral internal thoracic artery grafts are underused in the general population, and its use is controversial and debatable in diabetic patients due to long surgery duration, post-surgical bleeding, and sternal wound complications such as sternal wound infection, mediastinitis, and sternal wound dehiscence. This review article is particularly focused on deep sternal wound infection (DSWI) of bilateral internal thoracic artery (BITA) grafts in diabetic patients with comparison to single internal thoracic artery (SITA) graft.

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Bilateral Internal Thoracic Artery Grafting: Is It Reasonable in Octogenarians?

Cited by 11 publications

References 24 publications

Is Bilateral Internal Mammary Arterial Grafting Beneficial for Patients Aged 75 Years or Older?

Is Bilateral Internal Mammary Arterial Grafting Beneficial for Patients Aged 75 Years or Older?

Short-term results of bilateral internal mammary arterial grafting for patients aged 60–75 years – a retrospective study

Effect of bilateral internal thoracic artery harvesting on deep sternal wound infection in diabetic patients: Review of literature

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