Does the use of bilateral internal mammary artery (IMA) grafts provide incremental benefit relative to the use of a single IMA graft? A meta-analysis approach

Rizzoli, Giulio; Schiavon, Laura; Bellini, Pierantonio

doi:10.1016/s1010-7940(02)00470-0

Cited by 129 publications

(70 citation statements)

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“…[13][14][15][16] Pooled analyses of observational studies suggest that, at 10 years, there are approximately 20% fewer deaths from any cause with bilateral internal-thoracic-artery grafting than with single internal-thoracic-artery grafting. [17][18][19][20][21] However, bilateral internal-thoracic-artery grafting has not been widely adopted because of three main factors: it is a more complex procedure, it is associated with a higher risk of sternal wound complications, and there is a lack of randomized evidence of benefit. [22][23][24] The Arterial Revascularization Trial (ART) was initiated in 2004 to address these concerns.…”

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Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts

et al. 2016

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med nejm.org BACKGROUNDThe use of bilateral internal thoracic (mammary) arteries for coronary-artery bypass grafting (CABG) may improve long-term outcomes as compared with the use of a single internal-thoracic-artery plus vein grafts. METHODSWe randomly assigned patients scheduled for CABG to undergo single or bilateral internal-thoracic-artery grafting in 28 cardiac surgical centers in seven countries. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome. Interim analyses were prespecified at 5 years of follow-up. RESULTSA total of 3102 patients were enrolled; 1554 were randomly assigned to undergo single internal-thoracic-artery grafting (the single-graft group) and 1548 to undergo bilateral internal-thoracic-artery grafting (the bilateral-graft group). At 5 years of follow-up, the rate of death was 8.7% in the bilateral-graft group and 8.4% in the single-graft group (hazard ratio, 1.04; 95% confidence interval [CI], 0.81 to 1.32; P = 0.77), and the rate of the composite of death from any cause, myocardial infarction, or stroke was 12.2% and 12.7%, respectively (hazard ratio, 0.96; 95% CI, 0.79 to 1.17; P = 0.69). The rate of sternal wound complication was 3.5% in the bilateralgraft group versus 1.9% in the single-graft group (P = 0.005), and the rate of sternal reconstruction was 1.9% versus 0.6% (P = 0.002). CONCLUSIONSAmong patients undergoing CABG, there was no significant difference between those receiving single internal-thoracic-artery grafts and those receiving bilateral internal-thoracic-artery grafts with regard to mortality or the rates of cardiovascular events at 5 years of follow-up. There were more sternal wound complications with bilateral internal-thoracic-artery grafting than with single internal-thoracicartery grafting. Ten-year follow-up is ongoing. (Funded by the British Heart Foundation and others; ART Current Controlled Trials number, ISRCTN46552265.)

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Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts

et al. 2016

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“…Aunque el uso de la AMI no ha reducido significativamente la prevalencia de reintervenciones en la serie de Sergeant et al 33 , la experiencia de la mayoría de los grupos muestra que el uso de la AMI izquierda para revascularizar la DA reduce el número de reintervenciones y el intervalo entre la primera y la segunda intervención 35,36 . La revascularización con las 2 AMI conlleva una reducción aún mayor de reoperaciones 22,[35][36][37] . El riesgo de la reintervención duplica el riesgo de la primera intervención 33,34 y está más relacionado con la mayor prevalencia de los factores de riesgo que con la técnica quirúrgica propiamente dicha 34,38 .…”

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“…La extensión del injerto es también una técnica segura con una permeabilidad mayor del 95% 46 , así como las anastomosis secuenciales, excepto cuando se revascularizan ramas marginales de la arteria circunfleja o distales de la arteria coronaria derecha 47 . El uso de las dos AMI, sin incrementar la mortalidad hospitalaria, mejora la supervivencia a largo plazo y reduce la prevalencia de reintervenciones 22,36,37,41,45 ; estas diferencias a favor de la doble AMI son mayores en los pacientes de edad avanzada con múltiples factores de riesgo que en los pacientes jóve-nes, durante los primeros 10 años postoperatorios 41 . Las reticencias al uso de la doble AMI en pacientes diabéticos ha quedado solventada con la disección de la AMI «esqueletizada» 48 .…”

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Cirugía coronaria. Evolución en la última década. Indicaciones y resultados actuales

Herreros

2005

Revista Española de Cardiología

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La cirugía coronaria está avalada por unos excelentes resultados, bien documentados a largo plazo como consecuencia de la revascularización completa y la utilización de una o 2 arterias mamarias. En este artículo se revisan los resultados y las indicaciones de la cirugía y se valoran los nuevos retos y las oportunidades que incluyen la cirugía más segura, menos agresiva y asociada a otros procedimientos quirúrgicos. El objetivo es desarrollar estrategias ligadas a un ciclo innovador que adapte la cirugía a las necesidades de la población, las nuevas tecnologías y a las actividades pioneras. INTRODUCCIÓNLa cirugía coronaria tiene un origen incierto, en función de la localización geográfica y las preferencias del autor: Senning en Europa (1966), Garrett (1996) Coronary artery bypass surgery is endorsed by the excellent, well-documented, long-term results that follow complete revascularization and the use of 1 or 2 mammary artery grafts. This article contains a review of the current indications for and the results of such surgery and an evaluation of new challenges and opportunities, including the implementation of safer and less aggressive surgery, and surgery associated with other operative procedures. The aim was to develop a strategy linked to a cycle of innovation that could be used to adapt surgery to the needs of the population, to new technologies, and to pioneering developments.

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“…multiple arterial grafts seems to be favorable in these patients [19]. There is recent evidence showing that bilateral internal thoracic artery grafts provide benefits to the long-term survival, although there are no randomized studies to support such findings [20].…”

Section: Introductionmentioning

confidence: 98%

Revascularização do miocárdio com emprego de ambas artérias mamárias internas em pacientes com diabetes mellitus

Martins¹,

Santos²,

Tirado³

et al. 2007

Rev Bras Cir Cardiovasc

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Revascularização do miocárdio com emprego de ambas artérias mamárias internas em pacientes com diabetes mellitusCoronary artery bypass grafting using both internal mammary arteries in patients with diabetes mellitus Abstract Objective: We sought to describe the use of both internal thoracic arteries (ITA) in patients with diabetes mellitus (DM) submitted to a coronary artery bypass grafting (CABG).Method: Between January 1995 to August 2005, 4,569 patients received isolated CABG in our institution. Of the initial population, 1,298 had DM. The median age of the patients was 62 years and total mortality rate was 2.18% (100 patients). Both internal thoracic arteries were used in 700 patients. Patients were divided into two groups: with DM (group I, 148 patients), and without DM (group II, 552 patients). Patient selection for double ITA grafting was based on coronary artery anatomy and on the quality of sternum. The later was evaluated during the sternal transsection. When these two factors were considered favorable, we have both ITAs dissected, regardless whether the patient had DM. During the dissection of both internal thoracic arteries, one must take care not to open the pleural spaces.Results: There was a small difference between the two groups in terms of morbidity and mortality.Conclusion: Our data suggests that patients with DM can benefit with the efficient use of both internal thoracic arteries with a small increase in the risk of complications, if its application is carefully indicated.

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Does the use of bilateral internal mammary artery (IMA) grafts provide incremental benefit relative to the use of a single IMA graft? A meta-analysis approach

Abstract: There is significant evidence in favor of decreasing death risk of bilateral versus single IMA procedure.

Cited by 129 publications

References 20 publications

Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts

Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts

Cirugía coronaria. Evolución en la última década. Indicaciones y resultados actuales

Revascularização do miocárdio com emprego de ambas artérias mamárias internas em pacientes com diabetes mellitus

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