Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience

Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0.3 at univariate analysis. Results Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3–9.9 and OR: 5.4, 95% CI: 1.3–21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2–33.5), that was unfailingly due to ungraftable right coronary artery targets. Discussion BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.

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Transit time flow measurement predicts graft patency in off-pump coronary artery bypass grafting upon 5-year angiographic follow-up

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01716-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Caiwu Zeng ◽

Xiaomi Li ◽

Yan Dai ◽

Ye Zhou ◽

Chenglong Li ◽

...

Keyword(s):

Coronary Artery ◽

Graft Failure ◽

Artery Bypass ◽

Bypass Graft ◽

Graft Patency ◽

Bypass Grafts ◽

Off Pump ◽

Time Flow ◽

Pump Coronary Artery Bypass

Abstract Objective This retrospective study sought to evaluate the efficacy of transit time flow measurement (TTFM) as a means of predicting bypass graft patency as assessed by coronary artery angiography upon 5-year follow-up. Methods Of 311 patients undergone isolated off-pump coronary artery bypass graft surgery from January 2014 through December 2014, 202 (65%) underwent both intraoperative TTFM and angiography at follow-up. 610 grafts, 202 left internal mammary artery grafts and 408 saphenous vein grafts were checked. Any grafts that exhibited Fitzgibbon type B or O lesions upon angiographic evaluation were considered to be failing. Receiver operating characteristic curves were used to identify the optimal TTFM values for predicting graft patency. Results A total of 610 grafts were included in this analysis, including 202 LIMA grafts and 408 SV grafts, of which 107, 129, 129, and 43 anastomosed to DIAG, OM, PDA, and PLA, respectively. LIMA, DIAG, OM, PDA, and PLA bypass grafts had overall patency rates of 95.0%, 74.8%, 73.6%, 71.5%, and 74.4%, respectively, upon 5-year follow up. No significant differences in TTFM values (MGF, PI, and DF) were observed when comparing outcomes associated with individual or sequential SV grafting. MGF was found to be predictive of graft failure regardless of the target vessel (P < 0.05). While PI was found to predict LIMA, OM, and PDA graft failure (P < 0.05), it was not associated with the failure of grafts associated with DIAG and PLA vessels. Similarly, DF was found to predict OM and PDA graft failure (P < 0.05), but was not significantly associated with the failure of grafts associated with LIMA, DIAG, or PLA vessels. Conclusion LIMA bypass grafts were associated with better 5-year graft patency relative to SV bypass grafts. Similar graft patency rates were observed for both individual and sequential bypass grafts. MGF was able to predict bypass graft failure in patients that underwent off-pump CABG surgery.

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Fractional flow reserve (FFR) guided vs angiography guided coronary artery bypass graft (CABG): a systematic review and meta-analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1474 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Bruno ◽

F D'Ascenzo ◽

G Marengo ◽

R Manfredi ◽

F Conrotto ◽

...

Keyword(s):

Coronary Artery ◽

Meta Analysis ◽

Artery Bypass ◽

Bypass Graft ◽

Fractional Flow ◽

Surgical Revascularization ◽

Off Pump ◽

Flow Reserve ◽

Hospitalization Time

Abstract Background A strategy of percutaneous coronary intervention (PCI) driven by FFR (Fractional Flow Reserve) has demonstrated to reduce adverse events through the “deferring” of unnecessary stenting procedures compared to PCI guided by angiographic evaluation of stenosis. Coronary Artery Bypass Graft (CABG) represents another option for revascularization, being superior to PCI in patients with diffuse disease. In this setting, some evidence has been provided about physiological driven CABG procedures, but studies reported contrasting results regarding clinical benefits and outcomes at follow up. The aim of this meta-analysis is to evaluate clinical and procedural impact of FFR versus angiographic guided surgical revascularization and assess outcomes at follow up. Methods All randomized controlled trials (RCTs) or observational studies with multivariable adjustment or propensity matching were included. MACE (Major Adverse Cardiac Events) was the primary end point, while its single components (death, myocardial infarction and revascularization) along with number of grafts and percent of off-pump CABG were the secondary ones. Of 86 studies identified, 4 articles were included in this review, representing a combined total of 777 patients (426 angio-guided and 351 FFR-guided). Mean age was 66±2.1, 80% man, 74% hypertension, 71% hyperlipidemia, 33% diabetes, 39% smokers. Mean EuroSCORE I was 2.7. 18% a prior MI, and 25% a prior PCI. Coronary lesions were allocated as follow: 36% left anterior descending artery, 32% circumflex artery, 27% right coronary artery. Mean follow up was 30 months. At the follow up, rates of MACE did not differ (MACE OR 1.31:0.88–1.96), as those of death (OR 1.47:0.86–2.51), of MI (OR 1.80:0.89–3.63), and of target vessel revascularization (1.03: 0.54–1.97.). FFR-guided CABG was associated with more off-pump surgical procedure (OR 0.58, IC 0.34–0.97) and shorter hospitalization time (8.2±2.49 vs 8,87±3,25 p<0.01). FFR- guided CABG was associated more frequently with off-pump surgical procedure (OR 0.58:0.34–0.97) with fewer anastomes (2.5 vs 3), leading to higher rates of global arteria revascularization in FFR group (56% vs. 45%) and higher rates of venous grafts in angio-guided group (55% vs. 44%). Shorter hospitalization time was recorded in FFR patients (8.2±2.49 vs 8,87±3,25 days, p<0.01). Graft patency at follow up was not statistically higher in the FFR guided group (OR 0.67, CI 95% 0.32–1,39, all CI 95%). Conclusions FFR-guided surgical revascularization is associated with more off-pump procedures, a lower number of surgical anastomoses and more arterial grafts compared to angiography guided CABG. These differences lead to a shorter hospitalization time in the FFR-guided group compared to the angiography-guided group. No difference between two groups in MACE, overall death and MI was observed during the follow up. RCT with longer follow up are needed to evaluate long term outcomes. Funding Acknowledgement Type of funding source: None

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Is the second internal thoracic artery better than the radial artery in total arterial off-pump coronary artery bypass grafting? A propensity score–matched follow-up study

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2013.02.012 ◽

2014 ◽

Vol 147 (2) ◽

pp. 632-638 ◽

Cited By ~ 39

Author(s):

Daniel Navia ◽

Mariano Vrancic ◽

Fernando Piccinini ◽

Mariano Camporrotondo ◽

Jorge Thierer ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Internal Thoracic Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

Off Pump ◽

Follow Up Study ◽

Pump Coronary Artery Bypass ◽

Better Than

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Respiratory physiotherapy and incidence of pulmonary complications in off-pump coronary artery bypass graft surgery: an observational follow-up study

BMC Pulmonary Medicine ◽

10.1186/1471-2466-9-36 ◽

2009 ◽

Vol 9 (1) ◽

Cited By ~ 33

Author(s):

Isabel Yánez-Brage ◽

Salvador Pita-Fernández ◽

Alberto Juffé-Stein ◽

Ursicino Martínez-González ◽

Sonia Pértega-Díaz ◽

...

Keyword(s):

Coronary Artery ◽

Artery Bypass ◽

Bypass Graft ◽

Pulmonary Complications ◽

Artery Bypass Graft ◽

Off Pump ◽

Follow Up Study ◽

Respiratory Physiotherapy ◽

Pump Coronary Artery Bypass

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Transit Time Flow Measurement Predicts Graft Patency in Off-pump Coronary Artery Bypass Grafting Upon 5-Year Angiographic Follow-up

10.21203/rs.3.rs-127853/v1 ◽

2020 ◽

Author(s):

caiwu zeng ◽

Xiaomi Li ◽

Yan Dai ◽

Ye Zhou ◽

Chenglong Li ◽

...

Keyword(s):

Coronary Artery ◽

Graft Failure ◽

Artery Bypass ◽

Bypass Graft ◽

Graft Patency ◽

Bypass Grafts ◽

Off Pump ◽

Time Flow ◽

Pump Coronary Artery Bypass

Abstract Objective: This retrospective study sought to evaluate the efficacy of transit time flow measurement (TTFM) as a means of predicting bypass graft patency as assessed by coronary artery angiography (CAG) upon 5-year follow-up. Method: Of 311 patients undergone isolated off-pump coronary artery bypass graft (CABG) surgery from January 2014 through December 2014, 202 (65%) underwent both intraoperative TTFM and angiography at follow-up. 610 grafts, 202 left internal mammary artery grafts and 408 saphenous vein grafts were checked. Any grafts that exhibited Fitzgibbon type B or O lesions upon angiographic evaluation were considered to be failing. Receiver operating characteristic (ROC) curves were used to identify the optimal TTFM values for predicting graft patency. Results: A total of 610 grafts were included in this analysis, including 202 LIMA grafts and 408 SV grafts, of which 107, 129, 129, and 43 anastomosed to DIAG, OM, PDA, and PLA, respectively. LIMA, DIAG, OM, PDA, and PLA bypass grafts had overall patency rates of 95.0%, 74.8%, 73.6%, 71.5%, and 74.4%, respectively, upon 5-year follow up. No significant differences in TTFM values (MGF, PI, and DF) were observed when comparing outcomes associated with individual or sequential SV grafting. MGF was found to be predictive of graft failure regardless of the target vessel (P<0.05). While PI was found to predict LIMA, OM, and PDA graft failure (P<0.05), it was not associated with the failure of grafts associated with DIAG and PLA vessels. Similarly, DF was found to predict OM and PDA graft failure (P<0.05), but was not significantly associated with the failure of grafts associated with LIMA, DIAG, or PLA vessels.Conclusion: LIMA bypass grafts were associated with better 5-year graft patency relative to SV bypass grafts. Similar graft patency rates were observed for both individual and sequential bypass grafts. TTFM was able to predict bypass graft failure in patients that underwent off-pump CABG surgery, with MGF cut-off values for LIMA, DIAG, OM, PDA, and PLA grafts being 14.5 mL/min, 14.5 mL/min, 14.5 mL/min, 13.5 mL/min, and 16.5 mL/min, respectively.

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Abstract 2278: Long Term Clinical Follow-up and Graft Patency of Off-pump vs On-pump Coronary Artery Surgery in Patients with ST-Segment Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.118.suppl_18.s_697 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Khalil Fattouch ◽

Giuseppe Runza ◽

Roberta Sampognaro ◽

Massimo Midiri ◽

Giovanni Ruvolo

Keyword(s):

Coronary Artery ◽

Artery Bypass ◽

Myocardial Revascularization ◽

Graft Patency ◽

Early Mortality ◽

Off Pump ◽

Significant Difference ◽

Pump Cabg

Off-pump coronary artery bypass grafting is better than on-pump in patients with STEMI underwent surgery within 2 days from onset of symptoms. Surgeons may be reluctant to use OPCAB due to concerns about completeness of myocardial revascularization and graft patency. The aim of this study was to assess long-term clinical outcomes and graft patency in this kind of patients. Participants in two previous randomized studies performed in our institution including 207 STEMI patients underwent emergent or urgent CABG within 48 hours from onset of symptoms were followed after surgery to assess graft patency and major adverse cardiac-related events (MACE). There were 145 patients operated in on-pump and 62 patients in off-pump. Patency was assessed by multidetector computed tomography coronary angiography (MDCTA) with a 64-slice scanner. Two blinded observers classified proximal, body and distal segments of each graft as occluded or not, or grade of stenosis. Clinical follow-up was obtained by our cardiologists. Overall early mortality was 5.3% (11 pts). Percentage of early mortality were 6.7% and 1.6% in on- and off-pump group respectively (p<0.05). Follow-up was obtained in all 196 survivors and was 100% complete. Overall late deaths occurred in 14 patients (7%) without statistical significant difference between both groups; of the remaining 182, 168 (92.3 %) had MDCTA scans (108 pts in on-pump vs 60 pts in off-pump). Patency was studied in 335 grafts in on-pump and 156 grafts in off-pump. Mean duration of follow-up were 38±16 months and 37±14 months for on- and off-pump, respectively. Overall, 449/491 (91.5%) of grafts were patent. Percentages of overall grafts classified as patent were similar in on-pump and off-pump groups (307/335, 91.6% and 142/156, 91% respectively) and for arterial and vein grafts separately. There were also no differences between groups in the incidence of late death and MACE. Long term graft patency and MACE are similar with on-pump vs off-pump CABG in high risk STEMI patients when operation was performed by experienced surgeons. Supported by this results and by low early mortality in off-pump group, we suggests strictly the use of off-pump CABG in this type of patients.

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Early results of off-pump coronary artery bypass graft surgery using bilateral internal thoracic artery grafts in octogenarian patients during ten years

Interactive Cardiovascular and Thoracic Surgery ◽

10.1510/icvts.2008.183244 ◽

2008 ◽

Vol 8 (1) ◽

pp. 104-107 ◽

Cited By ~ 5

Author(s):

M. El Diasty ◽

J. A. Gonzalez ◽

J. Perez ◽

F. Cid ◽

V. Mosquera ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Internal Thoracic Artery ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Off Pump ◽

Early Results ◽

Bilateral Internal Thoracic Artery ◽

Pump Coronary Artery Bypass

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On-Pump Coronary Artery Bypass Graft: The State of the Art

Reviews on Recent Clinical Trials ◽

10.2174/1574887114666190301142114 ◽

2019 ◽

Vol 14 (2) ◽

pp. 106-115 ◽

Cited By ~ 1

Author(s):

Giovanni Cuminetti ◽

Ivano Bonadei ◽

Enrico Vizzardi ◽

Edoardo Sciatti ◽

Roberto Lorusso

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Radial Artery ◽

Artery Bypass ◽

Bypass Graft ◽

Standard Of Care ◽

Coronary Intervention ◽

Diabetic Patients ◽

Off Pump

Background:Coronary artery bypass grafting (CABG) remains the standard of care for patients with coronary artery disease (CAD). Debate exists concerning several factors, which include percutaneous coronary intervention (PCI) vs. CABG, single vs. bilateral mammary artery grafts, radial artery vs. saphenous vein grafts, right internal mammary artery vs. radial artery grafts, endoscopic vs. open vein-graft harvesting, and on-pump vs. off- pump surgery.:Moreover, challenging is the management of diabetic patients with CAD undergoing CABG. This review reports current indications, practice patterns, and outcomes of CABG.Methods:Randomized controlled trials comparing CABG to other therapeutical strategies for CAD were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings.Results:Large multicenter randomized and observational studies (SYNTAX, BEST, PRECOMBAT, ASCERT) have reported excellent outcomes in CABG patients, with always fewer rates of operative mortality and major morbidity, than PCI. The 10-year follow-up of ARTS II trial showed no difference between single and bilateral mammary artery. BARI 2D, MASS II, CARDia, FREEDOM trials showed that CABG is the best choice for diabetic patients.Conclusion:CABG still represents one of the most widespread major surgeries, with well-known benefits on symptoms and prognosis in patients with CAD. However, further studies and follow-up data are needed to validate these evidences.

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