Left internal thoracic artery−radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: a prospective randomized evaluation

Muneretto, Claudio; Bisleri, Gianluigi; Negri, Alberto; Manfredi, Jacopo; Carone, Enrico; Morgan, Jeffrey A.; Metra, Marco; Dei, Livio

doi:10.1016/j.jtcvs.2003.08.004

Cited by 76 publications

(47 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study, we avoided the use of the RA in over 70-year-old patients, nevertheless recent studies showed better results of the RA compared to the SV in this group of patients, with a lower incidence of neurologic complications and similar mortality rates [25].…”

Section: Discussionmentioning

confidence: 87%

See 1 more Smart Citation

Estudo comparativo randomizado da evolução imediata dos pacientes com artéria radial anastomosada proximalmente na aorta ou como enxerto composto

Sobral¹,

Santos²,

Santos³

et al. 2006

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 87%

“…Vasospasms are an important complication of the RA and are described by some authors [13,15,25] and are highlighted as the main cause of graft failure [23]. Coronary lesions of less than 75% were related to the presence of competition of flow in the RA, leading to spasms and occlusion of the graft [7,13,19].…”

Section: Discussionmentioning

confidence: 99%

Estudo comparativo randomizado da evolução imediata dos pacientes com artéria radial anastomosada proximalmente na aorta ou como enxerto composto

Sobral¹,

Santos²,

Santos³

et al. 2006

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

“…Muneretto et al [30], also in a publication from 2004, compared the patency of RA and SV grafts over 12 months. The angiographic results of 152 patents distributed into two groups were evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…Studies from Category D were excluded from this systematic review. Two studies were classified in Category A (Dessai et al, 2004; Buxton et al, 2003) [29,30] and one study was classified as Category B (Muneretto et al, 2004) [31].…”

Section: Methodological Quality Of the Included Studiesmentioning

confidence: 99%

<![CDATA[<B>Radial artery versus saphenous vein to myocardial revascularization</B>: <B>meta-analysis (there is no statistically significant difference)</B>]]>

Locali¹,

Buffolo²,

Catani³

2006

Braz. j. cardiovasc. surg.

View full text Add to dashboard Cite

Artéria radial versus veia safena para revascularização do miocárdio: metanálise (não houve diferença estatisticamente significante)Radial artery versus saphenous vein to myocardial revascularization: meta-analysis (there is no statistically significant difference) AbstractObjective: To compare the effectiveness of the radial artery graft with the saphenous vein graft for myocardial revascularization in association with the internal thoracic artery.Methods: A systematic review of the literature was made, searching for articles in the MEDLINE and LILACS databases. Two independent researchers performed the selection of articles, carefully evaluating the methodology described in articles considered relevant to the subject. Only controlled trials with an adequate randomization system were included. In all situations, when the researchers did not reach an agreement, a consensus meeting was held. No restrictions were stipulated in respect to the follow-up period for the angiographic evaluation of the graft, the vessel treated or the characteristics of the patients included in the studies. The results are expressed as Relative Risks (RR), with 95% Confidence Intervals (CI) to compare the effectiveness between the radial artery and the saphenous vein.Results: Based on these criteria, three studies were included. We did not find statistical differences between the patencies of the grafts (RR 0.53 [95% IC 0. -2.18]).Conclusion: Despite the studies having good methodologies we did not observe statistically significant differences between the grafts. The statistical power of the meta-analysis is low and therefore, more randomized controlled trials are necessary, with adequate sample sizes to detect possible differences between the different treatments.Descriptors: Radial artery. Saphenous vein. Myocardial revascularization. Meta-analysis. 256LOCALI, RF ET AL -Radial artery versus saphenous vein to myocardial revascularization: meta-analysis (there is no statistically significant difference) Braz J Cardiovasc Surg 2006; 21(3): 255-261

show abstract

“…Muneretto, et al 42) published the results of a prospective trial enrolling 160 patients older than 70 years randomized to the use of RA or SVG as a second conduit. The RA group reported better results in terms of angiographic patency and lower recurrence of angina after a mean follow-up of 16 months.…”

Section: Radial Artery In the Elderlymentioning

confidence: 99%

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

Nicolini

Vezzani²,

Romano

et al. 2017

Int. Heart J.

View full text Add to dashboard Cite

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 ...

show abstract

Left internal thoracic artery−radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: a prospective randomized evaluation

Abstract: Left internal thoracic artery-radial artery composite grafts proved to be a safe procedure in elderly patients. It improved the clinical outcome, providing a significantly higher graft patency rate and a lower incidence of late cardiac events.

Cited by 76 publications

References 12 publications

Estudo comparativo randomizado da evolução imediata dos pacientes com artéria radial anastomosada proximalmente na aorta ou como enxerto composto

Estudo comparativo randomizado da evolução imediata dos pacientes com artéria radial anastomosada proximalmente na aorta ou como enxerto composto

<![CDATA[<B>Radial artery versus saphenous vein to myocardial revascularization</B>: <B>meta-analysis (there is no statistically significant difference)</B>]]>

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

Contact Info

Product

Resources

About