Unilateral Versus Bilateral Internal Mammary Revascularization

Dewar, Leith; Jamieson, W.R. Eric; Janusz, Michael T.; Adeli-Sardo, M.; Eva, Gudumac; MacNab, Joan S.; Tyers, G. Frank O.

doi:10.1161/01.cir.92.9.8

Cited by 71 publications

(38 citation statements)

References 15 publications

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“…The proportions of diabetic patients in different reports vary from 5% to 100%. 3,6,7,11,14 Patients with a history of CABG were excluded 2,5,7,12 or included. 11 Emergency cases were excluded 2,14 or included.…”

Section: Discussionmentioning

confidence: 99%

“…3,6,7,11,14 Patients with a history of CABG were excluded 2,5,7,12 or included. 11 Emergency cases were excluded 2,14 or included. 11 Hospital mortality was excluded 6,7,10 or included 3,5,15,16 in the long-term overall survival rate.…”

Section: Discussionmentioning

confidence: 99%

“…11 Emergency cases were excluded 2,14 or included. 11 Hospital mortality was excluded 6,7,10 or included 3,5,15,16 in the long-term overall survival rate. Important variables that may influence the event-free rates were not included in many analyses.…”

Section: Discussionmentioning

confidence: 99%

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Benefit of Bilateral Over Single Internal Mammary Artery Grafts for Multiple Coronary Artery Bypass Grafting

et al. 2001

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Background-The aim of this study was to evaluate the performance of bilateral internal mammary artery (BIMA) grafts in isolated CABG. Methods and Results-Beginning in April 1985, elective primary multiple CABG for multivessel disease was performed in 1131 patients. The early and late results of 688 patients who received single internal mammary artery (SIMA) grafts and 443 patients who received BIMA grafts were compared (median follow-up, 6.15 years). Hospital mortality was not significantly different in the SIMA (0.9%) and BIMA (0.9%) groups. Graft patency was 97.3% in the BIMA group and 94.3% in the SIMA group (PϽ0.0001). The 7-year repeated CABG-free rate was significantly higher in the BIMA group (Pϭ0.026). The 7-year new myocardial infarction-free rate in all patients tended to be higher in the BIMA group (Pϭ0.06). The hazard ratio for all death or repeated CABG in patients with ejection fractions Ͼ0.4 and age Ͻ71 years was lower in the BIMA group (Pϭ0.0499). Conclusions-Our data suggest that the use of BIMA grafts in patients with in situ coronary artery anastomoses achieves a significantly higher repeated CABG-free rate in all patients compared with the use of SIMA. (Circulation. 2001;104: 2164-2170.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Benefit of Bilateral Over Single Internal Mammary Artery Grafts for Multiple Coronary Artery Bypass Grafting

et al. 2001

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“…In a similar casematched study from Tokyo, 10 multiple IMA did not alter the 7-year survival, but redo coronary bypass rates were signifi- cantly reduced. In 2 other case-matched and 1 comprehensive series, [12][13][14] survival benefits of multiple IMA grafting could not be demonstrated, although trends were evident toward improved cardiovascular outcomes in many areas. It should be emphasized that few of these studies contained follow-up data beyond 10 years.…”

Section: Burfeind Et Al Multiple Ima Ii-31mentioning

confidence: 89%

“…[1][2][3][4] However, studies comparing multiple to single IMA grafting have yielded mixed results, preventing definite conclusions. [5][6][7][8][9][10][11][12][13][14][15] Most analyses have been observational, have exhibited significant selection biases, and have required major statistical modeling to compare clinically disparate subgroups. Additionally, because a single IMA graft provides a strong survival advantage by itself, it would take a large number of patients and lengthy follow-up to show an incremental benefit of multiple IMA grafting.…”

mentioning

confidence: 99%

Single Versus Multiple Internal Mammary Artery Grafting for Coronary Artery Bypass

et al. 2004

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Background-The long-term clinical advantages of using routine multiple internal mammary artery (IMA) grafts for coronary artery bypass (CAB) are not clear. This study was designed to test the hypothesis that multiple IMA grafts would provide better 15-year outcomes when compared with single IMA and vein grafts. Methods and Results- Between 1984Between and 1987Between , 1067 consecutive patients undergoing isolated CAB were referred to 1 surgeon practicing primarily single and another surgeon maximizing multiple IMA grafts (clinical practice trial). A 207-patient subset with multiple IMAs underwent postoperative graft angiography at 1 to 32 weeks to define initial IMA patency. Patients were followed-up yearly, and the groups were analyzed as (I) surgical strategy (surgeon operating) (singleϭ413 versus multipleϭ654), (II) ultimate operation performed (singleϭ418 versus multipleϭ449), or (III) single versus multiple coronary systems revascularized with IMAs (singleϭ490 versus multipleϭ377). Advantages of this study design were that an entire referral population was examined, multiple IMAs were applied to the entire spectrum of baseline patient risk, 15-year follow-up provided a complete prognostic picture, and the subgroups were potentially comparable at baseline. In all 3 analyses, single and multiple groups were statistically similar with respect to baseline, operative, and immediate postoperative variables. Early IMA patency was 98.5% (333/338 grafts patent), validating the quality of IMA procedures. Unadjusted and adjusted 15-year outcome analyses for I, II, and III for death, myocardial infarction, percutaneous coronary intervention, redo coronary bypass, and the composite of all events identified multiple versus single as a significant predictor of outcome for the composite end point in adjusted analysis III (hazard ratioϭ0.808; 95% CI, 0.689 to 0.948; Pϭ0.009), because of a 5% to 10% absolute reduction in each of the outcome variables at 15 years. Moreover, Ͼ50% reduction in reoperation rate was observed at 15 years in every analysis. Conclusions-At 15-year follow-up, multiple IMA grafting was associated with a 19.2% adjusted risk reduction in death and cardiac events, caused by decreases in all adverse end points and fewer reoperations. These data indicate that the clinical advantages of maximizing IMA conduits are significant. Based on this information, it is suggested that multiple IMA grafting to 2 coronary systems should be applied liberally to patients with noncardiac risk profiles predictive of long-term survival.

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Rheolytic thrombectomy in the treatment of acute limb-threatening ischemia: Immediate results and six-month follow-up of the multicenter AngioJet® registry

Silva

Ramee

Collins

et al. 1998

Cathet. Cardiovasc. Diagn.

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Unilateral Versus Bilateral Internal Mammary Revascularization

Abstract: UL and BL mammary artery revascularizations have the same early mortality regardless of age but do not reveal any advantage for BL revascularization at 5 to 7 years.

Cited by 71 publications

References 15 publications

Benefit of Bilateral Over Single Internal Mammary Artery Grafts for Multiple Coronary Artery Bypass Grafting

Benefit of Bilateral Over Single Internal Mammary Artery Grafts for Multiple Coronary Artery Bypass Grafting

Single Versus Multiple Internal Mammary Artery Grafting for Coronary Artery Bypass

Rheolytic thrombectomy in the treatment of acute limb-threatening ischemia: Immediate results and six-month follow-up of the multicenter AngioJet® registry

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