Impact of the Radial Artery as an Additional Arterial Conduit During In-Situ Bilateral Internal Mammary Artery Grafting: A Propensity Score-Matched Study

Mohammadi, Siamak; Dagenais, François; Voisine, Pierre; Dumont, Éric; Charbonneau, Éric; Marzouk, Mohamed; Paramythiotis, Andreas; Kalavrouziotis, Dimitri

doi:10.1016/j.athoracsur.2015.08.054

Cited by 28 publications

(40 citation statements)

References 20 publications

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“…In fact the use of the RA per se does not increase operative mortality [14] and the RA patency has been demonstrated to be non-inferior to SV patency at early angiographic follow-up [15]. Mohammadi et al [7] recently reported comparable long term survival in 249 matched pairs of patients receiving BITA+RA versus BITA+SV (P=0.44). However, the main limitation of this study is that many of the RA grafts (41.4%) were placed to noncritical coronary targets (ie, stenosis 50% to 70%).…”

Section: Discussionmentioning

confidence: 75%

“…The right internal thoracic artery (RITA) has been advocated to further improve long term revascularization outcomes [2]. Whether the use of the radial artery (RA) [3][4][5] as third arterial conduit in addition to bilateral internal thoracic artery (BITA) grafting is associated with better survival when compared to BITA plus saphenous vein (SV) remains to be determined with isolated small series reporting conflicting results [6,7].…”

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confidence: 99%

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Are three arteries better than two? Impact of using the radial artery in addition to bilateral internal thoracic artery grafting on long-term survival

Benedetto

Caputo

Zakkar

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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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 Are three arteries better then two? Impact of using the radial artery in addition to bilateral internal thoracic artery grafting on long term survival. Umberto Central messageLong term survival in the context of bilateral internal thoracic artery grafting is not extended by using the radial artery in preference to saphenous vein in select low risk patients. Perspective statementLong term survival in the context of bilateral internal thoracic artery grafting is not extended by using the radial artery as the third arterial conduit in preference to saphenous vein also in select low risk patients. More data are needed before it is clear whether vein graft should be preferred as third conduit in this setting. AbstractObjective: Whether the use of the radial artery (RA) as third arterial conduit in addition to bilateral internal thoracic artery (BITA) is associated with better survival when compared to BITA plus saphenous vein (SV) remains to be determined. Methods:The study population included a select low risk group of 275 subjects who received BITA grafting with the RA as third arterial conduit (BITA+RA group) and 489 subjects who received BITA grafting with additional SV graft (BITA+SV). The RA was considered only in case of target stenosis ≥75%. We finally obtained 275 propensity score matched pairs for comparison. Conclusions: Long term survival in a select low risk group of patients receiving BITA grafting was not extended by using the RA as the third arterial conduit in preference to SV.Word count: 248

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Section: Discussionmentioning

confidence: 75%

mentioning

confidence: 99%

Are three arteries better than two? Impact of using the radial artery in addition to bilateral internal thoracic artery grafting on long-term survival

Benedetto

Caputo

Zakkar

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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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%

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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“…27 Contrarily, another group reported that use of an RA graft vs. SVG graft did not improve late survival in any age group. 28 Elderly patients requiring coronary revascularization tend to have decreased renal function and systemic arterial sclerosis. We think that the use of a 3rd or 4th arterial graft in elderly patients should be carefully determined based on the types of comorbidities that may be present, the patient's daily activity level, and angiographic findings.…”

Section: Disclosuresmentioning

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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Impact of the Radial Artery as an Additional Arterial Conduit During In-Situ Bilateral Internal Mammary Artery Grafting: A Propensity Score-Matched Study

Abstract: The use of the RA as an additional arterial graft in patients undergoing coronary artery bypass graft surgery with in-situ BIMA does not prolong late survival when compared with BIMA patients who received additional SVG.

Cited by 28 publications

References 20 publications

Are three arteries better than two? Impact of using the radial artery in addition to bilateral internal thoracic artery grafting on long-term survival

Are three arteries better than two? Impact of using the radial artery in addition to bilateral internal thoracic artery grafting on long-term survival

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

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

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