Long-Term Outcome of Total Arterial Myocardial Revascularization Versus Conventional Coronary Artery Bypass in Diabetic and Non-Diabetic Patients: A Propensity-Match Analysis

Bacco, Lorenzo Di; Repossini, Alberto; Muneretto, Claudio; Torkan, Lawrence; Bisleri, Gianluigi

doi:10.1016/j.carrev.2019.09.018

Cited by 10 publications

(15 citation statements)

References 26 publications

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“…All reported a general trend of benefit with TAG especially at 10 and 15 year follow-up, with most studies reaching statistical significance. 9 - 11 , 13 , 15 - 17 , 19 …”

Section: Resultsmentioning

confidence: 99%

“… 16 At 34 months, Muneretto et al reported better patency in the TAG arm (96.4% vs 83.2%, P=0.02) and a lower incidence of cardiac related events as reported earlier. 15 In diabetic patients, subanalysis of the study of Di Bacco et al 19 concluded that long-term survival following TAG is remarkably improved compared to conventional CABG especially in diabetic patients; among diabetics, vein grafts was the strongest predictor of MACCEs (HR 2.41; 95% CI 1.27–4.59, P=0.007) and cardiac mortality (HR 3.24; 95% CI 1.69–6.23, P=0.001). 19 …”

Section: Resultsmentioning

confidence: 99%

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Outcomes of total arterial revascularization vs conventional revascularization in patients undergoing coronary artery bypass graft surgery: A narrative review of major studies

Dominici

Chello²,

Saeed³

2022

Pak J Med Sci

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Coronary artery bypass grafting (CABG) is a widely used surgical procedure which improves clinical outcomes in appropriately selected patients. Conventionally, the greater saphenous vein is often used in CABG. However, due to their higher long-term patency rates, arterial conduits are routinely used, with the left internal thoracic artery (LITA) on left anterior descending (LAD) being the gold standard in CABG. Our aim in the present work was to investigate the outcomes of a total arterial grafting (TAG) on the whole heart, with no use of venous grafts, compared to mixed conduits in real-world data. A literature search was conducted in the bibliographic databases PubMed and Web of Science. Only studies comparing TAG with conventional CABG (at least one venous graft plus one or more arterial grafts), with at least one hundred patients in each group were included in this review. After study selection, a total of 15 relevant studies were evaluated and discussed in the present review. Results indicated that TAG is a highly efficient technique, and multiple arterial grafts can be used to reliably revascularize all coronary artery territories. TAG was more beneficial in terms of both short and long-term outcomes and its use should be encouraged. Large randomized clinical trials are needed to confirm the superiority of total arterial grafting with regard to long-term outcomes. doi: https://doi.org/10.12669/pjms.38.5.5674 How to cite this:Dominici C, Chello M, Saeed S. Outcomes of total arterial revascularization vs conventional revascularization in patients undergoing coronary artery bypass graft surgery: A narrative review of major studies. Pak J Med Sci. 2022;38(5):---------. doi: https://doi.org/10.12669/pjms.38.5.5674 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…All reported a general trend of benefit with TAG especially at 10 and 15 year follow-up, with most studies reaching statistical significance. 9 - 11 , 13 , 15 - 17 , 19 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Outcomes of total arterial revascularization vs conventional revascularization in patients undergoing coronary artery bypass graft surgery: A narrative review of major studies

Dominici

Chello²,

Saeed³

2022

Pak J Med Sci

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“…This method gave the best performances in terms of patency rate and long-term results according to proponents. 6 We assumed that it is not wise to do this kind of surgery routinely, especially for people older than 69 years.…”

Section: Discussionmentioning

confidence: 99%

“…We observe that our patients have a higher prevalence of hypertension (86.2% vs. 68.6%) and hypercholesterolemia (81% vs. 41%) in comparison with another study. 6,8 The use of LIMA to the LAD is the essential factor for survival and reduction of the late cardiac events after CABG. A study by Tatoulis et al has shown that after 10 years, LIMA has patency over 96% to the LAD and 89% to the circumflex (Cx).…”

Section: Discussionmentioning

confidence: 99%

Prediction value of EuroSCORE II in total arterial revascularization and its usage in the evaluation of postoperative complications: Single-center experience

Milutinovic

Krasić

Živković

et al. 2021

Asian Cardiovasc Thorac Ann

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Background Total arterial revascularization is the most durable and technically the most demanding type of coronary artery bypass grafting procedure. It has proven long-term supremacy in comparison to conventional coronary artery bypass grafting. In our study, we investigated the reliability of EuroSCORE II as a predictor of intrahospital death. We showed its impact on adverse perioperative events. Methods In this nonrandomized prospective study, we analyzed 116 consecutive patients who underwent the total arterial revascularization procedure at our Institute from January 2011 until the present. For myocardial revascularization, the most suitable combinations with left internal mammary artery, right internal mammary artery, and radial artery grafts were used. Main fact in this research was intrahospital mortality value in comparison with the value predicted. Results There were 104 (89.7%) males and 12 (10.3%) females. Mean preoperative EuroSCORE II prediction value was 1.98% and postoperative we obtained 1.72%. Postoperative redo for bleeding was 6%. Positive correlation was proven between the EuoroSCORE II value and intensive care unit stay (0.452; p < 0.001). Among patients who received two internal mammary arteries, the highest EuroSCORE II was among those with presternal wound infection (p = 0.005). Patients with bilateral internal mammary arteries and diabetes showed that they have the highest values of EuroSCORE II and, at the same time, that they are extremely prone to wound problems. Conclusions We achieved a lower intrahospital mortality level than it was predicted with preoperative EuroSCORE II value. This tool is a reliable method for preoperative death risk calculation in this group of patients.

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“…The beneficial effects noted by arterial grafts across age ranges, especially the benefit among this oldest group of patients and among those with diabetes, may be derived from the reduction of atherosclerotic progression facilitated by arterial grafts. 29,30 Since TAR's efficacy and safety have been proven 31,32 and has been shown to correlate with decreased MACCE 30 within this age range the application of TAR within this age group may better minimize the risk of further atherosclerotic progression than with the use of only veins or a mix of arteries and veins (►Fig. 5).…”

Section: Cad In Patients Between 60 and 80 Yearsmentioning

confidence: 99%

Does Age Affect the Short- and Long-Term Outcomes of Coronary Bypass Grafting?

et al. 2021

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The etiology of coronary artery disease (CAD) is multifactorial, stemming from both modifiable and nonmodifiable risk factors such as age. Several studies have reported the effects of age on various outcomes of coronary artery bypass grafting (CABG). This article reviews age-related outcomes of CABG and offers direction for further studies in the field to create comprehensive, evidence-based guidelines for the treatment of CAD. Ninety-two primary sources were analyzed for relevance to the subject matter, of which 17 were selected for further analysis: 14 retrospective cohort studies, 2 randomized clinical trials, and 1 meta-analysis. Our review revealed four broad age ranges into which patients can be grouped: those with CAD (1) below the age of 40 years, (2) between the ages of 40 and 60 years, (3) between the ages of 60 and 80 years, and (4) at or above 80 years. Patients below the age of 40 years fare best overall with total arterial revascularization (TAR). Patients between the ages of 40 and 60 years also fare well with the use of multiarterial grafts (MAGs) whereas either MAGs or single-arterial grafts may be of significant benefit to patients at or above the age of 60 years, with younger and diabetic patients benefitting the most. Arterial grafting is superior to vein grafting until the age of 80 years, at which point there is promising evidence supporting the continued use of the saphenous vein as the favored graft substrate. Age is a factor affecting the outcomes of CABG but should not serve as a barrier to offering patients CABG at any age from either a cost or a health perspective. Operative intervention starts to show significant mortality consequences at the age of 80 years, but the increased risk is countered by maintenance or improvement to patients' quality of life.

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Long-Term Outcome of Total Arterial Myocardial Revascularization Versus Conventional Coronary Artery Bypass in Diabetic and Non-Diabetic Patients: A Propensity-Match Analysis

Cited by 10 publications

References 26 publications

Outcomes of total arterial revascularization vs conventional revascularization in patients undergoing coronary artery bypass graft surgery: A narrative review of major studies

Outcomes of total arterial revascularization vs conventional revascularization in patients undergoing coronary artery bypass graft surgery: A narrative review of major studies

Prediction value of EuroSCORE II in total arterial revascularization and its usage in the evaluation of postoperative complications: Single-center experience

Does Age Affect the Short- and Long-Term Outcomes of Coronary Bypass Grafting?

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