Does it make sense to use two internal thoracic arteries?

Berreklouw, Eric; Schönberger, Jacques P.A.M.; Ercan, Hüsamettin; Koldewijn, Evert L.; Bock, Marcel de; Verwaal, Victor J.; Linden, Frits van der; Tweel, Ingeborg van der; Bavinck, Johannus H.; Bredée, Johan J.

doi:10.1016/0003-4975(95)00183-l

Cited by 49 publications

(14 citation statements)

References 12 publications

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“…In a similar casematched study from Tokyo, 10 multiple IMA did not alter the 7-year survival, but redo coronary bypass rates were signifi- cantly reduced. In 2 other case-matched and 1 comprehensive series, [12][13][14] survival benefits of multiple IMA grafting could not be demonstrated, although trends were evident toward improved cardiovascular outcomes in many areas. It should be emphasized that few of these studies contained follow-up data beyond 10 years.…”

Section: Burfeind Et Al Multiple Ima Ii-31mentioning

confidence: 99%

“…[1][2][3][4] However, studies comparing multiple to single IMA grafting have yielded mixed results, preventing definite conclusions. [5][6][7][8][9][10][11][12][13][14][15] Most analyses have been observational, have exhibited significant selection biases, and have required major statistical modeling to compare clinically disparate subgroups. Additionally, because a single IMA graft provides a strong survival advantage by itself, it would take a large number of patients and lengthy follow-up to show an incremental benefit of multiple IMA grafting.…”

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confidence: 99%

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Single versus multiple internal mammary artery grafting for coronary artery bypass: 15-year follow-up of a clinical practice trial

Burfeind¹,

Glower²,

Wechsler³

2005

ACC Current Journal Review

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Background-The long-term clinical advantages of using routine multiple internal mammary artery (IMA) grafts for coronary artery bypass (CAB) are not clear. This study was designed to test the hypothesis that multiple IMA grafts would provide better 15-year outcomes when compared with single IMA and vein grafts. Methods and Results- Between 1984Between and 1987Between , 1067 consecutive patients undergoing isolated CAB were referred to 1 surgeon practicing primarily single and another surgeon maximizing multiple IMA grafts (clinical practice trial). A 207-patient subset with multiple IMAs underwent postoperative graft angiography at 1 to 32 weeks to define initial IMA patency. Patients were followed-up yearly, and the groups were analyzed as (I) surgical strategy (surgeon operating) (singleϭ413 versus multipleϭ654), (II) ultimate operation performed (singleϭ418 versus multipleϭ449), or (III) single versus multiple coronary systems revascularized with IMAs (singleϭ490 versus multipleϭ377). Advantages of this study design were that an entire referral population was examined, multiple IMAs were applied to the entire spectrum of baseline patient risk, 15-year follow-up provided a complete prognostic picture, and the subgroups were potentially comparable at baseline. In all 3 analyses, single and multiple groups were statistically similar with respect to baseline, operative, and immediate postoperative variables. Early IMA patency was 98.5% (333/338 grafts patent), validating the quality of IMA procedures. Unadjusted and adjusted 15-year outcome analyses for I, II, and III for death, myocardial infarction, percutaneous coronary intervention, redo coronary bypass, and the composite of all events identified multiple versus single as a significant predictor of outcome for the composite end point in adjusted analysis III (hazard ratioϭ0.808; 95% CI, 0.689 to 0.948; Pϭ0.009), because of a 5% to 10% absolute reduction in each of the outcome variables at 15 years. Moreover, Ͼ50% reduction in reoperation rate was observed at 15 years in every analysis. Conclusions-At 15-year follow-up, multiple IMA grafting was associated with a 19.2% adjusted risk reduction in death and cardiac events, caused by decreases in all adverse end points and fewer reoperations. These data indicate that the clinical advantages of maximizing IMA conduits are significant. Based on this information, it is suggested that multiple IMA grafting to 2 coronary systems should be applied liberally to patients with noncardiac risk profiles predictive of long-term survival.

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Section: Burfeind Et Al Multiple Ima Ii-31mentioning

confidence: 99%

mentioning

confidence: 99%

Single versus multiple internal mammary artery grafting for coronary artery bypass: 15-year follow-up of a clinical practice trial

Burfeind¹,

Glower²,

Wechsler³

2005

ACC Current Journal Review

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“…While bilateral internal thoracic artery (BITA) can improve long-term survival [1][2][3][4][5], some reports have shown an increased perioperative mortality, a higher incidence of complications, or reoperations for bleeding [6][7][8] as well as the absence of a significant benefit after BITA grafting.…”

Section: Introductionmentioning

confidence: 99%

Does bilateral ITA grafting increase perioperative complications?☆Outcome of 4462 patients with bilateral versus 4204 patients with single ITA bypass

Gansera

Schmidtler

Gillrath

et al. 2006

European Journal of Cardio-Thoracic Surgery

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CABG using both ITAs can be performed routinely with good clinical results and low mortality. Compared with single ITA grafting, sternal and bleeding complications were slightly increased. Diabetes mellitus, BITA grafting, duration of surgery but not obesity or COPD could be identified as independent risk factors for sternal complications. Dialysis-dependent renal failure, EF<30%, emergent cases, and the absence of BITA grafting were predictors for increased perioperative mortality.

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“…Since the original reports from the Cleveland Clinic 1,2 the internal thoracic artery (ITA) has been established as the conduit of choice for revascularization of the left anterior descending artery (LAD). However, the advantages of its use over that of the saphenous vein (SV) for revascularization of the circumflex (RCX) or right coronary artery (RCA) are still debated 3‐6 . With the revival of off‐pump coronary artery bypass grafting (OPCAB), transient time flow measurement (TTFM) has been introduced as an effective and reliable means for intraoperative evaluation of coronary grafts 7‐9 .…”

mentioning

confidence: 99%

Superior Flow Pattern of Internal Thoracic Artery over Saphenous Vein Grafts during OPCAB Procedures

Weber

Tavakoli

Genoni

2009

Journal of Cardiac Surgery

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Does it make sense to use two internal thoracic arteries?

Cited by 49 publications

References 12 publications

Single versus multiple internal mammary artery grafting for coronary artery bypass: 15-year follow-up of a clinical practice trial

Single versus multiple internal mammary artery grafting for coronary artery bypass: 15-year follow-up of a clinical practice trial

Does bilateral ITA grafting increase perioperative complications?☆Outcome of 4462 patients with bilateral versus 4204 patients with single ITA bypass

Superior Flow Pattern of Internal Thoracic Artery over Saphenous Vein Grafts during OPCAB Procedures

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