Abstract 520: Should Bilateral Internal Thoracic Artery Grafting be Used in Patients with Peripheral Vascular Disease?

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Nadav Teich ◽  
Benjamin Medalion ◽  
Dmitry Pevni ◽  
Rephael Mohr ◽  
Amir Kramer ◽  
...  
Keyword(s):  
Vascular Disease ◽  
Internal Thoracic Artery ◽  
Cox Model ◽  
Chronic Obstructive Lung Disease ◽  
Emergency Operation ◽  
Rank Test ◽  
Chronic Obstructive ◽  
Increased Risk ◽  
Bilateral Internal Thoracic Artery ◽  
Sternal Wound Infections

Background: The potential survival benefit of Bilateral Internal Thoracic Artery (BITA) compared to Single Internal Thoracic Artery (SITA) grafting in peripheral or cerebral vascular disease (PVD) patients is questionable, due to their short life expectancy and increased risk of sternal wound infection. Methods: Six hundreds and four Patients with PVD who underwent BITA grafting between 1996 and 2010 were compared with 478 PVD patients who underwent SITA grafting. Results: Patients undergoing SITA were older, more often female, more likely to have chronic obstructive lung disease, EF<30% ,Diabetes, renal insufficiency, congestive heart failure and emergency operation. Euroscore of SITA patients was significantly higher(10.1 ±3.1vs. 8.1± 3.3 %,p<0.001) Operative mortality (4.4% vs. 5.0% in BITA and SITA)and sternal wound infections (4.4% vs. 3.6%) were not significantly different between groups. Median follow-up was 9.50 (95%CI 8.83-10.16) years. Ten-year survival (Kaplan-Meier ) of the SITA and BITA groups were not significantly different (45.1±4.7% vs. 50.1±3.4%, P =0.736, Log Rank test) and assignment to the BITA group was not associated with better propensity-adjusted survival (HR 1.050, 95% CI: 0.875-1.261, P =0.600) ( Stratified COX model. ) Conclusions: This study shows. that, early and long-term outcomes of BITA grafting in patients with PVD are not better than those of SITA grafting. Early mortality from non-cardiac causes ,reduces the influence of the type of conduit used(BITA or SITA) on survival. Selective use of BITA in lower-risk PVD patients might un-mask the benefits of BITA grafting

Abstract 331: Are Two Internal Thoracic Grafts Better Than One in Patients With Peripheral Vascular Disease?: Analysis of 858 Cases Between 1996- 2011

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Nadav Teich ◽  
Refael Mohr ◽  
Demitry Pevni ◽  
Yael Assaig ◽  
Amir Kramer ◽  
...  
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Coronary Disease ◽  
Cox Model ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Peripheral Vascular ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Increased Risk

Objectives: Bilateral internal thoracic artery( ITA) grafting is associated with improved survival. However, potential survival benefit of using two ITA`s in patients with peripheral vascular disease(PVD) is questionable due to their short life expectancy and the increased risk of sternal wound infection(SWI) compare to operations incorporating single ITA (SITA). The purpose of this study is to compare early and long-term outcome of bilateral ITA grafting(BITA) to that of SITA and vein grafts in PVD patients with multi-vessels coronary disease. Methods: Five hundred and thirty three PVD patients who underwent BITA between 1996 and 2011 were compared with 319 who underwent SITA . Results: SITA patients were more often female, more likely to have Diabetes, chronic obstructive lung disease, unstable angina, previous CABG, renal insufficiency, Cerebro- vascular disease and emergency operation .On the other hand congestive heart failure and triple vessel coronary disease were more prevalent among BITA patients. Operative mortality(3.5% vs. 4.1%, in the SITA and BITA respectively) and occurrences of SWI (6.6% vs 3.9%) and strokes(4.1% vs 6.8%) were not significantly different between groups . BITA patients did not have better Kaplan- Meier 10 year survival ( 52.1% vs.47.1%, p=0.145) and after propensity score matching(243 well matched pairs) BITA was not associated with better adjusted survival ( HR 1.108[95%CI 0.810-1.516] p=0.521)(cox model) Conclusion: This study does not support routine use of BITA in PVD patients .Earlier mortality from non-cardiac causes, reduces contribution of BITA and increases the influence of PVD and other co-morbidities on survival. Selective use of BITA in lower risk patients might un-mask the benefits of BITA

Abstract 40: Should Bilateral Internal Thoracic Artery Grafting Be Used in Emergency Patients?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yanai Ben-Gal ◽  
Rephael Mohr ◽  
Dimitri Pevni ◽  
Amir Ganiel ◽  
Amir Kramer ◽  
...  
Keyword(s):  
Internal Thoracic Artery ◽  
Cox Model ◽  
Rank Test ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Emergency Patients ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Bilateral Internal Thoracic Artery

HYPOTHESIS: Bilateral Internal Thoracic Artery (BITA) grafting is not often used in emergency coronary artery bypass grafting (CABG) due to questionable survival benefit ,relative complexity and increased risk of sternal infection compared to operations incorporating Single Internal Thoracic Artery (SITA). The purpose of this study is to compare early and long term outcome of emergent patients undergoing BITA grafting, to that of emergent patients undergoing CABG with SITA METHODS: Four hundred thirty eight emergency patients underwent BITA grafting between 1996 and 2008. They were compared with 339 emergency patients who underwent CABG with SITA RESULTS: Occurrence of female gender (18.5% vs. 29.5%, P< 0.001, in the BITA and SITA groups, respectively), diabetes (25.3% vs. 38.6%, P< 0.001), age 70+ (61.0% vs.39.7%, P< 0.001), chronic obstructive pulmonary disease (5.7% vs.13.9%, P< 0.001) EF <30% (12.1% vs. 17.1%, P< 0.001), and chronic renal failure (7.1% vs. 17.1%, p< 0.001) was lower in the BITA group. On the other hand critical preoperative state (35.4% vs. 26.0%, P= 0.003), and recent myocardial infarction (39.5% vs. 32.7%, P= 0.031) were more prevalent among BITA patients. Euro score I of SITA patients was significantly higher (10.58 ± 4.1 vs.8.65 ± 3.5, P= 0.016). Operative mortality (5.3% vs 7.4%, BITA vs. SITA), and sternal wound infections (2.7% vs. 2.1%) were not significantly different between groups. Mean follow-up was 8.75 ± 4.75 years. Ten year survival (Kaplan-Meier) of SITA patients with euro score 11+ was similar to that of BITA patients with euro score 11+. (34% vs. 37%, log rank test) .However, Kaplan-Meier 10 year survival of BITA patients with euro score I of 10 or lower was significantly better(80% vs. 68%, , BITA and SITA groups, respectively , P= 0.012 ).Assignment to the BITA group in the subset with lower euro score was also associated with better propensity adjusted survival ( HR 4.8 p < 0.001, compared to the SITA group, COX model) CONCLUSIONS: This large cohort study shows that,BITA grafting may be used in emergency patients., In medium and low risk emergency patients long term outcome is better than that of patients treated with SITA

scholarly journals Are two internal thoracic grafts better than one? An analysis of 5301 cases

2019 ◽  
Vol 56 (5) ◽  
pp. 935-941 ◽  
Author(s):  
Dmitry Pevni ◽  
Rephael Mohr ◽  
Amir Kramer ◽  
Yosef Paz ◽  
Nachum Nesher ◽  
...  
Keyword(s):  
Internal Thoracic Artery ◽  
Cox Model ◽  
Myocardial Revascularization ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Matched Cohort ◽  
Entire Cohort ◽  
Sternal Infection ◽  
Kaplan Meier ◽  
Increased Risk

Abstract OBJECTIVES Although bilateral internal thoracic artery (BITA) grafting is associated with improved survival, many surgeons are reluctant to use this technique due to its greater complexity and the potentially increased risk of sternal infection. This observational study examined if BITA grafting provides improved outcomes compared with single internal thoracic artery (SITA) grafting in patients with multivessel coronary disease. METHODS Patients in our institution who underwent BITA grafting during 1996–2011 were compared to those who underwent SITA grafting during the same period. To adjust for differences in demographic and clinical characteristics, patients were matched by propensity score. The Cox model was used to identify predictors of decreased survival and the Kaplan–Meier analysis was performed, both for the entire cohort and for the matched cohort. RESULTS SITA patients were older than BITA patients, included more females, and were more likely to have chronic obstructive lung disease, an ejection fraction <30%, diabetes, renal insufficiency, peripheral vascular disease and emergency and repeat operations. Three-vessel and left main diseases were more common among BITA patients, and operative mortality was reduced (2.1% vs 3.6% for SITA, P = 0.002). Sternal infection and stroke rates were similar for the groups. Ten-year Kaplan–Meier survival of BITA patients was better (71.2% vs 56.8%, respectively, P < 0.001). BITA grafting was found to be a predictor of better survival in the analysis of the matched cohort (P < 0.001). CONCLUSIONS Our results support the routine use of BITA grafting in patients who undergo myocardial revascularization.

Prognostic impact of chemoradiation-related lymphopenia in patients with gastric and gastroesophageal cancer.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 249-249
Author(s):  
Daniel W Kim ◽  
Grace Lee ◽  
Theodore S. Hong ◽  
Guichao Li ◽  
Eric Roeland ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Cox Model ◽  
Gastroesophageal Junction ◽  
Concurrent Chemotherapy ◽  
Rank Test ◽  
Prognostic Impact ◽  
Poor Prognostic Factor ◽  
Risk Of Death ◽  
Increased Risk ◽  
Ecog Ps

249 Background: Limited data exists on how chemoradiation (CRT)-induced lymphopenia affects survival outcomes in patients with gastric and gastroesophageal junction (GEJ) cancer. We evaluated the association between severe lymphopenia and its association with survival in gastric and GEJ cancer patients treated with CRT. We hypothesized that severe lymphopenia would be a poor prognostic factor. Methods: We performed a retrospective analysis of 154 patients with stage 1-3 gastric or GEJ cancer who underwent CRT at our institution. Patients underwent photon-based radiation therapy (RT) with a median dose of 50.4 Gy (IQR 45.0-50.4 Gy) over 28 fractions and concurrent chemotherapy (CTX) with carboplatin/paclitaxel, 5-fluorouracil based regimen, or capecitabine. 49% received CTX prior to RT. 84% underwent surgical resection, 57% pre-CRT and 26% post-CRT. Absolute lymphocyte count (ALC) at baseline and at 2 months since initiating RT were analyzed. Severe lymphopenia, defined as Grade 3 or worse lymphopenia (ALC < 0.5 k/μl), was analyzed for any association with overall survival (OS). Results: Median time of follow up was 48 months. Median age was 65. 77% were male and 86% were Caucasian. ECOG PS was 0 or 1 in 90% and 2 in 10%. Tumor location was stomach in 38% and GEJ in 62%. Timing of CRT was preoperative among 68% and postoperative among 32%. The median ALC at baseline for the entire cohort was 1.6 k/ul (range 0.3-7.0 k/ul). At 2 months post-CRT, 49 (32%) patients had severe lymphopenia. Patients with severe lymphopenia post-CRT had a slightly lower baseline TLC compared to patients without severe lymphopenia (median TLC 1.4 k/ul vs. 1.6 k/ul; p = 0.005). There were no differences in disease and treatment characteristics between the two groups. On the multivariable Cox model, severe lymphopenia post-CRT was significantly associated with increased risk of death (HR = 3.99 [95% CI 1.55-10.28], p = 0.004). ECOG PS 2 (HR = 34.97 [95% CI 2.08-587.73], p = 0.014) and postoperative CRT (HR = 5.55 [95% CI 1.29-23.86], p = 0.021) also predicted worse OS. The 4-year OS among patients with severe lymphopenia was 41% vs. 61% among patients with vs. without severe lymphopenia (log-rank test p = 0.041). Conclusions: Severe lymphopenia significantly correlated with poorer OS in patients with gastric or GEJ cancer treated with CRT. CRT-induced lymphopenia may be an important prognostic factor for survival in this patient population. Closer observation in high-risk patients and treatment modifications may be potential approaches to mitigating CRT-induced lymphopenia.

Maximum tumor dimension and tumor volume as prognostic factors in patients with newly diagnosed localized Ewing sarcoma (ES)- a report from the Children’s Oncology Group (COG).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11529-11529
Author(s):  
Leo Mascarenhas ◽  
Allen Buxton ◽  
Steven G. DuBois ◽  
Dian Wang ◽  
Nadia N. Laack ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Prognostic Factors ◽  
Tumor Size ◽  
Tumor Volume ◽  
Cox Model ◽  
Rank Test ◽  
Newly Diagnosed ◽  
Phase 3 ◽  
Increased Risk ◽  
Significant Difference

11529 Background: Maximum tumor dimension > 8 cm. and large tumor volume have been reported to be adverse prognostic factors in patients with ES but have not been prospectively evaluated in the context of a phase 3 clinical trial with interval compressed chemotherapy. Methods: COG AEWS1031 (NCT01231906) was a randomized phase 3 clinical trial comparing interval compressed chemotherapy regimens in patients with newly diagnosed localized ES of bone and soft tissue. A correlative objective of AEWS1031 was to evaluate tumor size and volume as prognostic factors. Institution-reported dimensions of the primary tumor from baseline imaging were prospectively collected. For inclusion in this analysis, patients had to have at least 1 tumor dimension reported for tumor size analyses and dimensions in 3 axes for tumor volume analyses. Maximum dimension was dichotomized as less than vs. > / = 8cm. Tumor volume was dichotomized as less than vs. > / = 200 mL. Event-free (EFS) and overall survival (OS) from enrollment were calculated using Kaplan-Meier methods and compared between groups using a two-sided log-rank test. Hazard ratios (HR) and confidence intervals (CI) were calculated using the Cox model. Results: The 5-year EFS and OS of the 629 eligible patients was 78% (95% CI: 75-81%) and 87% (95% CI: 84-90%) respectively and there was no significant difference in both EFS and OS between the randomized interval compressed chemotherapy arms of AEWS1031. 590 of 629 (94%) patients were evaluable for maximum tumor dimension and 307 (52%) had tumors > / = 8 cm. Patients with tumors > / = 8 cm were at significantly increased risk for EFS events (p = 0.016) with estimated 5-year EFS of 73.7% (95% CI: 68.1 vs.78.4%) vs. 82.9% (95% CI 77.7-87.1%) for patients with tumors < 8 cm [HR: 1.53 (1.08-2.17)]. For tumor volume, 586 of 629 patients (93%) were evaluable and 180 (31%) had tumors > / = 200 mL. Patients with tumor volume > / = 200 mL were at significantly increased risk for EFS events (p = 0.003) with estimated 5-year EFS of 70% (95% CI: 62.3-76.4%) vs. 81.6% (95% CI: 77.2-85.2%) for patients with tumors < 200 mL [HR: 1.69 (1.2-2.39)]. Conclusions: Maximum tumor dimension and tumor volume as defined are both prognostic in patients with newly diagnosed localized ES treated with interval compressed chemotherapy. Clinical trial information: NCT01231906 .

scholarly journals Inhaled Corticosteroids and the Lung Microbiome in COPD

Biomedicines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1312
Author(s):  
Holly R. Keir ◽  
Marco Contoli ◽  
James D. Chalmers
Keyword(s):  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Inhaled Corticosteroids ◽  
Bacterial Load ◽  
Chronic Obstructive Lung Disease ◽  
Lower Airway ◽  
Chronic Obstructive ◽  
Pharmacological Management ◽  
Lung Microbiome ◽  
Increased Risk

The Global Initiative for Chronic Obstructive Lung Disease 2021 Report recommends inhaled corticosteroid (ICS)-containing regimens as part of pharmacological treatment in patients with chronic obstructive lung disease (COPD) and frequent exacerbations, particularly with eosinophilic inflammation. However, real-world studies reveal overprescription of ICS in COPD, irrespective of disease presentation and inflammatory endotype, leading to increased risk of side effects, mainly respiratory infections. The optimal use of ICS in COPD therefore remains an area of intensive research, and additional biomarkers of benefit and risk are needed. Although the interplay between inflammation and infection in COPD is widely acknowledged, the role of the microbiome in shaping lower airway inflammation has only recently been explored. Next-generation sequencing has revealed that COPD disease progression and exacerbation frequency are associated with changes in the composition of the lung microbiome, and that the immunosuppressive effects of ICS can contribute to potentially deleterious airway microbiota changes by increasing bacterial load and the abundance of potentially pathogenic taxa such as Streptococcus and Haemophilus. Here, we explore the relationship between microbiome, inflammation, ICS use and disease phenotype. This relationship may inform the benefit:risk assessment of ICS use in patients with COPD and lead to more personalised pharmacological management.

Chemoradiation-related lymphopenia and its association with survival in patients with anal cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 3-3
Author(s):  
Grace Lee ◽  
Daniel W. Kim ◽  
Vinayak Muralidhar ◽  
Devarati Mitra ◽  
Nora Horick ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Anal Cancer ◽  
Cox Regression ◽  
Cox Model ◽  
Rank Test ◽  
Anal Squamous Cell Carcinoma ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Increased Risk

3 Background: While treatment-related lymphopenia (TRL) is common and associated with poorer survival in multiple solid malignancies, little data exists for anal cancer. We evaluated TRL and its association with survival in anal cancer patients treated with chemoradiation (CRT). Methods: A retrospective analysis of 140 patients with non-metastatic anal squamous cell carcinoma (SCC) treated with definitive CRT was performed. Total lymphocyte counts (TLC) at baseline and monthly intervals up to 12 months after initiating CRT were analyzed. Multivariable Cox regression analysis was performed to evaluate the association between overall survival (OS) and TRL, dichotomized by G4 TRL ( < 0.2k/μl) two months after initiating CRT. Kaplan-Meier and log-rank tests were used to compare OS between patients with versus without G4 TRL. Results: Median time of follow-up was 55 months. Prior to CRT, 95% of patients had a normal TLC ( > 1k/μl). Two months after initiating CRT, there was a median of 71% reduction in TLC from baseline and 84% of patients had TRL: 11% G1, 31% G2, 34% G3, and 8% G4. On multivariable Cox model, G4 TRL at two months was associated with a 3.7-fold increased risk of death (p = 0.013). On log-rank test, the 5-year OS rate was shorter in the cohort with versus without G4 TRL at two months (32% vs. 86%, p < 0.001). Conclusions: TRL is common and may be another prognostic marker of OS in anal cancer patients treated with CRT. The association between TRL and OS supports the hypothesis that host immunity plays an important role in survival among patients with anal cancer. These results support ongoing efforts of randomized trials underway to evaluate the potential role of immunotherapy in localized anal cancer.

scholarly journals Low serum free light chain is associated with risk of COPD exacerbation

2020 ◽  
Vol 6 (2) ◽  
pp. 00288-2019
Author(s):  
Kazuya Tanimura ◽  
Susumu Sato ◽  
Atsuyasu Sato ◽  
Naoya Tanabe ◽  
Koichi Hasegawa ◽  
...  
Keyword(s):  
Antibody Production ◽  
Forced Expiratory Volume ◽  
Light Chains ◽  
Rank Test ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Baseline Serum ◽  
Serum Free Light Chain ◽  
Increased Risk ◽  
Tract Infections

BackgroundMost exacerbations of chronic obstructive pulmonary disease (COPD) are triggered by respiratory tract infections. Adaptive immunity via antibody production is important in preventing infections. Impaired antibody production is reported to be associated with an increased risk of exacerbations of COPD. In the present study, we elucidated whether reduced free light chains (FLCs), which are excessive amounts of light chains produced during antibody synthesis and can be used to estimate systemic antibody production, may be a promising biomarker to predict the risk of exacerbations of COPD.MethodsWe enrolled stable male patients with COPD and prospectively observed them for 2 years. At baseline, serum combined FLC (cFLC; sum of kappa and lambda values) and pulmonary function were evaluated. Exacerbation was defined as a worsening of symptoms requiring treatments with antibiotics, corticosteroids or both.Results63 patients with stable COPD were enrolled (72.8±8.1 years, GOLD A/B/C/D=24/28/6/5), and 51 patients completed the 2-year follow-up. Serum cFLC was 31.1 mg·L−1 on average and ranged widely (1.4 to 89.9 mg·L−1). The patients with low cFLC (below the mean−sd, n=6) experienced a significantly shorter time to the first exacerbation of COPD (p<0.0001 by the log-rank test). A multivariate Cox proportional hazard model, including the COPD assessment test score, % predicted forced expiratory volume in 1 s (FEV1 % pred), and number of previous exacerbations demonstrated that low cFLC and low FEV1 % pred were independently and significantly correlated with the risk for exacerbations of COPD.ConclusionLow cFLC may be a B-cell-associated novel biomarker associated with risk of COPD exacerbation.

Sign in / Sign up

Export Citation Format

Share Document