Long-term follow-up of total arterial myocardial revascularization using exclusively pedicle bilateral internal thoracic artery and right gastroepiploic artery

For the left coronary system, bilateral internal thoracic arteries (BITA) have demonstrated their superiority over all others types of grafts in terms of patency and survival benefit. Several configurations of BITA have been proposed to achieve left-sided myocardial revascularization. Because the ideal BITA assembling has not yet been found, we have prospectively randomized two types of BITA configurations to evaluate at 6 months and 3 years the clinical, functional and angiographic outcome.From 03/2003 to 08/2006, 1297 consecutive patients underwent isolated bypass surgery in our institution. Of this group, 481 patients met the entrance criteria for randomization and 304 (64%) patients were randomized. BITA grafting was performed with a pedicled configuration in 147 patients and with a Y configuration in 152. Patients were interviewed by telephone every 3 months and had a systematic stress test twice a year performed under supervision of their referring cardiologists. Systematic angiographic follow-up was performed 6 months after surgery. The primary and secondary end point was respectively the major adverse cerebro-cardiovascular events (MACCE) and the proportion of ITA grafts that were completely occluded at follow-up angiography. More arterial anastomoses were performed in patients randomized in the Y than in the pedicled configuration (3.2 versus 2.4; p< 0.001). There were no significant differences between the 2 groups in terms of hospital mortality or morbidity. Clinical follow-up is 100 % complete with a mean of 16 ± 11 months. At follow-up there is no significant difference in any MACCE rate between the 2 groups. Angiographic follow-up is 90% complete with a mean of 6.5 months. 432 out of 446 anastomosis in the BITA Y group and 278 out of 286 in the BITA pedicled group were controled patent (p=0.96).Excellent patency rates were achieved in both groups with no significant difference in terms of MACCE or patency. Whether the higher number of ITA distal anastomoses in the Y configuration group will translate in better long-term results remains to be established.

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Early myocardial revascularization for postinfarction angina: Results and long-term follow-up

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(85)80318-1 ◽

1985 ◽

Vol 6 (5) ◽

pp. 1121-1125 ◽

Cited By ~ 24

Author(s):

Arun K. Singh ◽

Robert Rivera ◽

George N. Cooper ◽

Karl E. Karlson

Keyword(s):

Myocardial Revascularization ◽

Long Term Follow Up

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Coronary-coronary bypass grafting: artery or vein?

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320941689 ◽

2020 ◽

Vol 28 (6) ◽

pp. 316-321

Author(s):

Vladlen Bazylev ◽

Evgeny Rosseikin ◽

Dmitriy Tungusov ◽

Artur Mikulyak

Keyword(s):

Myocardial Revascularization ◽

Coronary Bypass ◽

Long Term Results ◽

Bypass Grafting ◽

Coronary Bypass Grafting ◽

Coronary Bypass Grafts ◽

Long Term Follow Up ◽

Observation Period

Background The method of coronary-coronary bypass grafting was described in 1987 but has not been widely used, and there are only a few studies that report good short-term and mid-term results as well as some individual cases of long-term follow-up. In our medical institution, we carried out an analysis of the long-term results of coronary-coronary bypass grafting, which are presented in this study. Methods This was a retrospective single-center study on 95 patients who underwent coronary-coronary bypass grafting as a supplement to the standard coronary bypass grafting procedure. All patients underwent angiographic assessment of the coronary bypass grafts during the long-term follow-up period. The observation period was up to 123 months. Angiographic assessment of 109 coronary-coronary grafts was carried out. Results Twelve (7.6%) arterial and 11 (19.3%) venous conduits were found to be occluded, and 8 (10.3%) arterial and 10 (31.3%) venous coronary-coronary grafts were occluded during the observation period. Conclusion Arterial coronary-coronary artery bypass grafting represents an alternative technique that allows complete myocardial revascularization.

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Myocardial revascularization in patients with severe ischemic left ventricular dysfunction. Long term follow-up in 141 patients

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(01)00982-4 ◽

2001 ◽

Vol 20 (6) ◽

pp. 1157-1162 ◽

Cited By ~ 61

Author(s):

F. Bouchart ◽

A. Tabley ◽

P.Y. Litzler ◽

C. Haas-Hubscher ◽

J.P. Bessou ◽

...

Keyword(s):

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Myocardial Revascularization ◽

Left Ventricular ◽

Long Term Follow Up

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Abstract 2880: Age Cutoff For The Loss Of Benefit From Bilateral Internal Thoracic Artery Grafting

Circulation ◽

10.1161/circ.116.suppl_16.ii_641-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Siamak Mohammadi ◽

Francois Dagenais ◽

Patrick Mathieu ◽

Daniel Doyle ◽

Richard Baillot ◽

...

Keyword(s):

Survival Benefit ◽

Internal Thoracic Artery ◽

Cox Regression ◽

Statistical Significance ◽

Age Groups ◽

Vein Grafts ◽

Bilateral Internal Thoracic Artery ◽

Related Survival

Objectives : To identify the age-related benefit of single and bilateral internal thoracic artery (ITA) grafting on long-term cardiac-related survival in patients who survived from primary isolated coronary artery bypass grafting (CABG). Methods : A unicenter study was conducted on 12198 consecutive survivors from primary isolated CABG who received single (n=9533 patients) or bilateral (n=1388 patients) ITA grafts, or vein grafts only (n=1277 patients) between 1992 and 2005. Data was collected prospectively. The Cox regression model was used to estimate the hazard ratio of each independent variable on cardiac-specific survival over the entire length of follow-up. Age was a significant covariate into the statistical model. The mean follow-up was 5.7 ± 3.7 years and 100% complete as of December 2005. Results : After adjustments for different risk factors, the cardiac-related survival benefit in patients undergoing CABG with two ITAs was superior to that of single ITA grafting up to 60 years of age, displaying a constant decrease over time (Fig 1 ). The use of a single ITA was beneficial on cardiac-related survival in all age groups, including octogenarians, compared to patients receiving only vein grafts. Conclusions : The use of at least one ITA is associated with increased long-term cardiac-specific survival in all age groups compared to venous-only CABG. The additional cardiac-specific survival benefit of using a second ITA decreases gradually with age, and its statistical significance is lost after 60 years of age.

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Internal Thoracic Artery Side Branch Ligation for Post Coronary Surgery Ischemia

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230701500416 ◽

2007 ◽

Vol 15 (4) ◽

pp. 339-341 ◽

Cited By ~ 5

Author(s):

Kosmas Tsakiridis ◽

Dimitrios Mikroulis ◽

Vassilios Didilis ◽

Georgios Bougioukas

Keyword(s):

Stress Testing ◽

Internal Thoracic Artery ◽

Coronary Bypass ◽

Side Branch ◽

Coronary Surgery ◽

Recurrent Angina ◽

Long Term Follow Up ◽

Treadmill Stress

Two cases of internal thoracic artery side-branch ligation in patients with recurrent angina after coronary bypass are reported with long-term follow-up. Ligation was performed with clips via a left thoracotomy. Treadmill stress testing after 3 and 4 years did not provoke any myocardial ischemia. These findings suggest that an unligated side-branch can produce a steal phenomenon.

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The Prognostic Effect of Circadian Blood Pressure Pattern on Long-Term Cardiovascular Outcome Is Independent of Left Ventricular Remodeling

Journal of Clinical Medicine ◽

10.3390/jcm8122126 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2126 ◽

Cited By ~ 5

Author(s):

Marijana Tadic ◽

Cesare Cuspidi ◽

Vera Celic ◽

Biljana Pencic ◽

Giuseppe Mancia ◽

...

Keyword(s):

Blood Pressure ◽

Ventricular Remodeling ◽

Left Ventricular Remodeling ◽

Myocardial Revascularization ◽

Left Ventricular ◽

Hypertensive Patients ◽

Long Term Follow Up ◽

Reverse Dipping

We aimed to investigate the predictive value of 24 h blood pressure (BP) patterns on adverse cardiovascular (CV) outcome in the initially untreated hypertensive patients during long-term follow-up. This study included 533 initially untreated hypertensive patients who were involved in this study in the period between 2007 and 2012. All participants underwent laboratory analysis, 24 h BP monitoring, and echocardiographic examination at baseline. The patients were followed for a median period of nine years. The adverse outcome was defined as the hospitalization due to CV events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or CV death). During the nine-year follow-up period, adverse CV events occurred in 85 hypertensive patients. Nighttime SBP, non-dipping BP pattern, LV hypertrophy (LVH), left atrial enlargement (LAE), and LV diastolic dysfunction (LV DD) were risk factors for occurrence of CV events. However, nighttime SBP, non-dipping BP pattern, LVH, and LV DD were the only independent predictors of CV events. When all four BP pattern were included in the model, non-dipping and reverse dipping BP patterns were associated with CV events, but only reverse-dipping BP pattern was independent predictor of CV events. The current study showed that reverse-dipping BP pattern was predictor of adverse CV events independently of nighttime SBP and LV remodeling during long-term follow-up. The assessment of BP patterns has very important role in the long-time prediction in hypertensive population.

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