Multiple arterial grafting confers survival advantage compared to percutaneous intervention with drug-eluting stents in multivessel coronary artery disease: A propensity score adjusted analysis

Raja, Shahzad G.; Benedetto, Umberto; Ilsley, Charles; Amrani, Mohamed

doi:10.1016/j.ijcard.2015.04.059

Cited by 13 publications

(4 citation statements)

References 27 publications

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“…In this study, 60% of infected cases comprise 0.0% of non-infected cases. Findings are confirmed with previous study was in 2015 that compared coronary artery bypass graft patients who used arterial grafts from Right Internal Mammary Artery versus Radial Artery, which found 2.9% of Right Internal Mammary Artery patients and 4.7% of Radial Artery patients needed rewiring [40]. However, this study's findings were inconsistent with those of last study in 2014 that found 50% of patients undergoing Vacuum Assisted Closure needed rewiring but no patients receiving flap needed rewiring [41].…”

Section: Relationship Between Infected and Non-infected Cases Relatedsupporting

confidence: 89%

Nursing Evaluation of Risk Factors Associated with Surgical Site Infection Among Coronary Artery Bypass Graft Patients at King Abdulaziz University Hospital

Johani¹

2017

AJNS

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Abstract:Surgical site infection is postoperative wound infection that occurs after surgery. The complications in the acute care facilities with up to 60% of surgical site infection cases estimated to be preventable by using evidence-based practice. Not with standing the advances in the coronary artery bypass graft, the rising prevalence of surgical site infection has become a primary concern in the infection control practices. The current study amid to evaluate the risk factors associated with the surgical site infections among coronary artery bypass graft patients and, to assess nurses compliance to bundle care to prevent surgical site infection. The study followed a quantitative, retrospective design and was carried out in King Abdulaziz University Hospital in Jeddah city. All sample (n= 120) coronary artery by-pass graft patient's record complied between January 2011 to December 2013.The study revealed statistically significant results between the preference of surgical site infection and demographic factor e.g. body mass index, patient risk factors such as diabetes type1 and 2, selected pre-operative factors e.g. Methicilin-resistant staphylococcus aurous, postoperative factors e.g. rewiring, dressing, ventilation and low cardiac output. This study established that the compliance with the bundle was proven to be effective in reducing risk factors to surgical site infection however nurses adherence to surgical site infection bundle care were incomplete and required more enforcement to comply. Based on the finding, the investigator recommended that nurses should be aware of the importance of adhering to surgical site infection bundles. Nurses should not only be educated on the importance of the bundles, but on how effectives apply the bundles at different stages.

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Section: Relationship Between Infected and Non-infected Cases Relatedsupporting

confidence: 89%

Nursing Evaluation of Risk Factors Associated with Surgical Site Infection Among Coronary Artery Bypass Graft Patients at King Abdulaziz University Hospital

Johani¹

2017

AJNS

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“…Also, sternal wound infection among BIMA graft patients impedes cardiac surgeons from endorsing it as a regular conduit. 8,[12][13][14][15][16] Several published literature hypothesised that using multiple arterial grafts during myocardial revascularisation may provide better survival benefits than mixed arterial and venous grafts in CABG surgery. [5][6][7][8][9][10][11] In a randomised controlled trial (RCTs) of 1036 CABG patients, Gaudino and coworkers found radial-artery grafts have a lower adverse cardiac event and better graft patency rate over five years of follow-up, similar to our study results.…”

Section: Discussionmentioning

confidence: 99%

“…23 In a recent study, Rayol et al 24 observed the long-term benefits of total arterial revascularisation among the CABG population and encouraged the utilisation of arterial conduits, which concord with existing published results. [16][17][18][19][20][21][22] Similarly, a meta-analysis comparing survival benefits among bilateral and single internal mammary artery (BIMA versus SIMA) CABG patients by Yi and coworkers observed that BIMA has a higher survival rate with up to 10 years of follow-up, and long-term survival benefits seem to have a higher survival rate to continue in the second decade of post-CABG. 25 Nevertheless, Lüscher et al 26 and Otsuka et al 27 demonstrated that the preservation of graft patency rate is influenced by vascular endothelial nitric oxide (NO), which helps to maintain vascular tone by preventing platelet aggregation, thrombus formation, and smooth muscle cell proliferation.…”

Section: Discussionmentioning

confidence: 99%

Long Term Survival Benefits of Different Conduits Used in Coronary Artery Bypass Graft Surgery- A Single Institutional Practice Over 20 Years

Momin,

Ranjan,

Valencia

et al. 2024

JMDH

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This study determined hazard factors and long-term survival rate of total arterial coronary artery bypass graft surgery over 20 years in an extensively large, population-based cohort. Methods: A total of 2979 patients who underwent isolated CABG from April 1999 to March 2020 were studied in 4 groups-Group-A (bilateral internal mammary artery ± radial artery), Group-B (single internal mammary artery + radial artery ± saphenous vein), Group-C (single internal mammary artery ± saphenous vein; no radial artery), and Group-D (radial artery ± saphenous vein; no internal mammary artery). The study endpoints analysed the correlation between the number and types of grafts with the survival time following isolated CABG surgery. Results: The total arterial revascularization (Group A) group had an admirable mean long-term survival of ~19 years, compared to 18.6 years (Group B), 15.86 years (Group C), and 10.99 years (Group D). A Kaplan-Meier curve demonstrated confidence interval (CI) for study groups-(95% CI 18.33-19.94), (95% CI 18.14-19.06), (95% CI 15. in Group A, B, C, D respectively. In the Holm-Sidak method analysis, significant associations existed between the number of arterial grafts and the long-term outcome. A statistically significant (P≤0.05) long-term survival advantage for arterial grafting was demonstrated, especially total arterial revascularisation over all other combinations except single internal mammary artery + radial artery grafting. Conclusion:In this series, over 20 years, total arterial CABG use has excellent long-term survival, achieving complete myocardial revascularisation. There is no significant difference between the BIMA group and SIMA with radial artery. However, there is a reduced survival with decreased use of arterial conduits.

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“…3,[60][61][62][63] It remains a matter of debate whether the use of bi-lateral IMA further displays the superiority of CABG over PCI, because no study has been specifically designed with this aim in the elderly population. Recently, Raja, et al 64) reported the results of their retrospective single center study comparing SITA grafting or multiple arterial grafting versus PCI with DES/BMS in a large population with a mean age of 65 years. Propensity score adjusted analysis was performed to investigate the potential survival advantage of multiple arterial grafting over PCI.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

Nicolini

Vezzani²,

Romano

et al. 2017

Int. Heart J.

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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 ...

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Multiple arterial grafting confers survival advantage compared to percutaneous intervention with drug-eluting stents in multivessel coronary artery disease: A propensity score adjusted analysis

Cited by 13 publications

References 27 publications

Nursing Evaluation of Risk Factors Associated with Surgical Site Infection Among Coronary Artery Bypass Graft Patients at King Abdulaziz University Hospital

Nursing Evaluation of Risk Factors Associated with Surgical Site Infection Among Coronary Artery Bypass Graft Patients at King Abdulaziz University Hospital

Long Term Survival Benefits of Different Conduits Used in Coronary Artery Bypass Graft Surgery- A Single Institutional Practice Over 20 Years

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

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