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

Circulation ◽  
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.

scholarly journals Bilateral internal thoracic artery grafting in haemodialysis patients with diabetic nephropathy

2020 ◽  
Vol 31 (6) ◽  
pp. 774-780
Author(s):  
Kohei Hachiro ◽  
Takeshi Kinoshita ◽  
Tomoaki Suzuki ◽  
Tohru Asai
Keyword(s):  
Diabetic Nephropathy ◽  
Internal Thoracic Artery ◽  
Cox Regression ◽  
Statistical Significance ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
University Hospital ◽  
Deep Sternal Wound Infection ◽  
Significant Difference

Abstract OBJECTIVES To compare postoperative outcomes in patients with diabetic nephropathy receiving haemodialysis and undergoing isolated coronary artery bypass grafting (CABG) using bilateral or single skeletonized internal thoracic artery (ITA). METHODS Among 1441 consecutive patients undergoing isolated CABG between 2002 and 2019 at our university hospital, we retrospectively analysed data for 107 patients with diabetic nephropathy receiving haemodialysis. After inverse probability of treatment weighting, we found no statistically significant differences regarding patients’ preoperative characteristics. RESULTS All patients underwent myocardial revascularization using the off-pump technique. There was no statistical significance in postoperative deep sternal wound infection (P = 0.902) and 30-day mortality (P = 0.755). However, the bilateral ITA group had a lower rate of postoperative stroke versus the single group (0% vs 5.5%, respectively; P = 0.021). Follow-up was completed in 95.3% (102/107) of the patients, and the mean follow-up duration was 3.3 years. Thirty-eight deaths occurred in the bilateral ITA group and 18 in the single ITA group. There was no significant difference in all-cause death (P = 0.558) and cardiac death rates (P = 0.727). Multivariable Cox regression models showed that the independent predictors of all-cause death were age [hazard ratio (HR) 1.031; P = 0.010], previous percutaneous intervention (HR 1.757; P = 0.009) and gastroepiploic artery grafting (HR 0.582; P = 0.026). CONCLUSIONS Bilateral ITA grafting in patients with diabetic nephropathy receiving haemodialysis did not improve mid-term outcomes.

scholarly journals Bilateral internal thoracic artery grafting in coronary surgery: 10-year outcomes

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P D'Errigo ◽  
F Barili ◽  
S Rosato ◽  
F Biancari ◽  
F Cerza ◽  
...  
Keyword(s):  
Public Health ◽  
Protective Factor ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Cox Proportional Hazards ◽  
Public Health Perspective ◽  
Bilateral Internal Thoracic Artery ◽  
Priority Project

Abstract Background The advantages to use the bilateral internal thoracic artery grafting (BITA) technique for coronary artery bypass grafting (CABG) have been recently questioned, but data on long-term follow-up is limited. Using data from the PRIORITY project, this study aims to assess the outcome with the use of BITA grafting and its implications for public health. Methods The PRIORITY project was planned to evaluate the long-term outcomes of two prospective multicenter studies on CABG conducted between 2002-2004 and 2007-2008. Data on isolated CABG were linked to administrative data in order to retrieve patients' late outcome. Time-to-event distributions were analyzed accordingly to primary event-type (death, major adverse cardiac events (MACEs)) using the Kaplan-Meier and the Cox proportional hazards methods. Results The study population consisted of 11021 patients who underwent isolated CABG. BITA grafting was employed in 24.6% of patients. The median follow-up time was 8.0 years (interquartile range 7.6-10.0 years). After adjustment for potential confounding factors, BITA grafting was significantly associated with better survival (HR 0.85, 95%CI 0.76-0.95, p = 0.003). Moreover, using BITA grafting reduced the incidence of MACE (HR 0.87, 95%CI 0.80-0.94, p = 0.001), showing to be a protective factor for recurrent acute myocardial infarction (HR 0.84, 95%CI 0.71-0.99, p = 0.05) and for rehospitalization for percutaneous cardiac intervention (HR 0.82, 95%CI 0.70-0.96, p = 0.013). Conclusions BITA grafting during isolated CABG is associated with survival advantage at 10-year with a significantly reduced incidence of MACE. Being the choice to perform isolated CABG with or without BITA based mainly on operator personal preferences, these findings may have important implications from a public health perspective. Key messages The choice to perform CABG with or without BITA grafting is associated to different outcomes. The choice to perform CABG with or without BITA grafting is mainly based on operator preferences and may have important implications in terms of healthcare expenditures.

Abstract 2879: Comparison of Bilateral Internal Thoracic Artery Revascularization Using Pedicled or Y Graft Configurations: A Prospective Randomized Clinical, Functional and Angiographic Mid-term Evaluation.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
David Glineur ◽  
Claude Hanet ◽  
Philippe Noirhomme ◽  
Alain Poncelet ◽  
Jean Christophe Funken ◽  
...  
Keyword(s):  
Internal Thoracic Artery ◽  
Stress Test ◽  
Myocardial Revascularization ◽  
Long Term Results ◽  
Significant Difference ◽  
Bilateral Internal Thoracic Artery ◽  
Term Evaluation ◽  
The Ideal

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.

scholarly journals Early and late outcomes of single versus bilateral internal thoracic artery revascularization for patients in critical condition

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255740
Author(s):  
Michal Fertouk ◽  
Amit Gordon ◽  
Dmitry Pevni ◽  
Tomer Ziv-Baran ◽  
Orr Sela ◽  
...  
Keyword(s):  
Critical Condition ◽  
Internal Thoracic Artery ◽  
Multivariable Analysis ◽  
Interquartile Range ◽  
Term Survival ◽  
Long Term Survival ◽  
Bilateral Internal Thoracic Artery ◽  
Critical Patients

Objective The optimal surgical approach for critically ill patients with complex coronary disease remains uncertain. We compared outcomes of bilateral internal thoracic artery (BITA) versus single ITA (SITA) revascularization in critical patients. Methods We evaluated 394 consecutive critical patients with multi-vessel disease who underwent CABG during 1996–2001. Outcomes measured were early mortality, strokes, myocardial-infarctions, sternal infections, revisions for bleeding, and late survival. The critical preoperative state was acknowledged concisely by one or more of the following: preoperative ventricular tachycardia/fibrillation, aborted sudden cardiac death, or the need for mechanical ventilation or for preoperative insertion of intra-aortic-balloon counter-pulsation. Results During the study period, 193 of our patients who underwent SITA and 201 who underwent BITA were in critical condition. The SITA group was older (mean 68.0 vs. 63.3 years, p = 0.001) and higher proportions were females (28.5% vs. 18.9% p = 0.025), after recent-MI (69.9% vs. 57.2% p = 0.009) and with left-main disease (38.3% vs. 49.3% p = .029); the median logistic EuroSCORE was higher (0.2898 vs. 0.1597, p<0.001). No statistically significant differences were observed between the SITA and BITA groups in 30-day mortality; and in rates of early CVA, MI and sternal infections (13.0% vs. 8.5%, p = 0.148; 4.1% vs. 6.0%, p = 0.49; 6.7% vs. 4.5%, p = 0.32 and 2.1% vs. 2.5%, p>0.99, respectively). Long-term survival (median follow-up of 15 years, interquartile-range: 13.57–15) was better in the BITA group (median 14.39 vs. 9.31± 0.9 years, p = 0.001). Propensity-score matching (132 matched pairs) also yielded similar early outcomes and improved long-term survival (median follow-up of 15 years, interquartile-range: 13.56–15) for the BITA group (median 12.49±1.71 vs. 7.63±0.99 years, p = 0.002). In multivariable analysis, BITA revascularization was found to be a predictor for improved survival (hazard-ratio of 0.419, 95%CI 0.23–0.76, p = 0.004). Conclusions This study demonstrated long-term survival benefit for BITA revascularization in patients in a critical pre-operative state who presented for surgical revascularization.

Abstract 19433: Should Bilateral Internal Thoracic Artery Grafting be Used in Patients After Recent MI?

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Dan Loberman ◽  
Rephael Mohr ◽  
Mohamad Medleg ◽  
Nachum Nesher ◽  
Zahi Aizer ◽  
...  
Keyword(s):  
Internal Thoracic Artery ◽  
Cox Model ◽  
Statistical Significance ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Kaplan Meier ◽  
Triple Vessel Disease ◽  
Proper Patient Selection ◽  
Bilateral Internal Thoracic Artery

Introduction: Bilateral internal thoracic artery(ITA) grafting is associated with improved survival. However, many surgeons are reluctant to use this revascularization technique in patients after myocardial infarction (MI) due to the risk of sternal infection and the excellent survival benefit obtained with single ITA (SITA). Hypothesis: Long-term outcome of bilateral ITA (BITA) grafting, might be superior to single ITA and other conduits such as saphenous veins (SVG) and radial artery (RA) in patients with multi-vessels disease after recent MI. Methods: 871 patients who underwent BITA grafting after recent MI (<3 months prior to surgery), between 1996 and 2010, Were compared with 527 who underwent CABG with SITA and SVG or RA. Results: Patients undergoing SITA were older, more often female, more likely to have COPD, EF<30%, preoperative critical state, Diabetes, chronic renal failure (CRF), peripheral vascular disease (PVD) and emergency operation. In contrast, patients undergoing BITA grafting were more likely to have triple vessel disease and more often underwent CABG with three or more grafts and sequential grafts. Operative mortality of BITA patients was lower (3.0 % vs. 5.7%, in the SITA group p=0.01), Occurrences of sternal wound infection (3% vs 2%) and strokes (2.6% vs. 3%) were similar. Mean follow-up was 11.8 (95%CI 10.95-12.56) years. Kaplan Meier survival of BITA patients was better (70.3% vs.52.6% p<0.001). Propensity score matching was used to account for differences between groups in preoperative characteristics. The 293 matched pairs thus created had similar preoperative characteristics. Kaplan Meier 10 year survival (67.3% versus 59%, p=0.325 log-rank test), and the Cox adjusted survival of the matched groups did not reach statistical significance (HR 1.57, p=0.091). However, survival of non- emergent BITA patients was better (HR 1.256 p=0.038). Age, COPD, CHF, CRF, PVD and left main were independent predictors of decreased survival. Off-pump operations were associated with improved survival (Cox model) Conclusions: This study suggests that long-term outcome of arterial revascularization with BITA can be better than that of SITA in non-emergency cases after recent MI with proper patient selection

Long-Term Clinical Outcome in Elderly Patients Undergoing Mitral Valve Repair

2020 ◽  
Author(s):  
Julia Götte ◽  
Armin Zittermann ◽  
Kavous Hakim-Meibodi ◽  
Masatoshi Hata ◽  
Rene Schramm ◽  
...  
Keyword(s):  
Mitral Valve ◽  
General Population ◽  
Elderly Patients ◽  
Cox Regression ◽  
Functional Class ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Cox Regression Analysis

Abstract Background Long-term data on patients over 75 years undergoing mitral valve (MV) repair are scarce. At our high-volume institution, we, therefore, aimed to evaluate mortality, stroke risk, and reoperation rates in these patients. Methods We investigated clinical outcomes in 372 patients undergoing MV repair with (n = 115) or without (n = 257) tricuspid valve repair. The primary endpoint was the probability of survival up to a maximum follow-up of 9 years. Secondary clinical endpoints were stroke and reoperation of the MV during follow-up. Univariate and multivariable Cox regression analysis was performed to assess independent predictors of mortality. Mortality was also compared with the age- and sex-adjusted general population. Results During a median follow-up period of 37 months (range: 0.1–108 months), 90 patients died. The following parameters were independently associated with mortality: double valve repair (hazard ratio, confidence interval [HR, 95% CI]: 2.15, 1.37–3.36), advanced age (HR: 1.07, CI: 1.01–1.14 per year), diabetes (HR: 1.97, CI: 1.13–3.43), preoperative New York Heart Association (NYHA) functional class (HR: 1.41, CI: 1.01–1.97 per class), and operative creatininemax levels (HR: 1.32, CI: 1.13–1.55 per mg/dL). The risk of stroke in the isolated MV and double valve repair groups at postoperative year 5 was 5.0 and 4.1%, respectively (p = 0.65). The corresponding values for the risk of reoperation were 4.0 and 7.0%, respectively (p = 0.36). Nine-year survival was comparable with the general population (53.2 vs. 53.1%). Conclusion Various independent risk factors for mortality in elderly MV repair patients could be identified, but overall survival rates were similar to those of the general population. Consequently, our data indicates that repairing the MV in elderly patients represents a suitable and safe surgical approach.

scholarly journals Coronary artery aneurysms: outcomes following medical, percutaneous interventional and surgical management

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001440
Author(s):  
Shameer Khubber ◽  
Rajdeep Chana ◽  
Chandramohan Meenakshisundaram ◽  
Kamal Dhaliwal ◽  
Mohomed Gad ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Surgical Management ◽  
Medical Management ◽  
Cox Regression ◽  
Artery Bypass ◽  
Management Strategies ◽  
Coronary Artery Aneurysms ◽  
Kaplan Meier

BackgroundCoronary artery aneurysms (CAAs) are increasingly diagnosed on coronary angiography; however, controversies persist regarding their optimal management. In the present study, we analysed the long-term outcomes of patients with CAAs following three different management strategies.MethodsWe performed a retrospective review of patient records with documented CAA diagnosis between 2000 and 2005. Patients were divided into three groups: medical management versus percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). We analysed the rate of major cardiovascular and cerebrovascular events (MACCEs) over a period of 10 years.ResultsWe identified 458 patients with CAAs (mean age 78±10.5 years, 74.5% men) who received medical therapy (N=230) or underwent PCI (N=52) or CABG (N=176). The incidence of CAAs was 0.7% of the total catheterisation reports. The left anterior descending was the most common coronary artery involved (38%). The median follow-up time was 62 months. The total number of MACCE during follow-up was 155 (33.8%); 91 (39.6%) in the medical management group vs 46 (26.1%) in the CABG group vs 18 (34.6%) in the PCI group (p=0.02). Kaplan-Meier survival analysis showed that CABG was associated with better MACCE-free survival (p log-rank=0.03) than medical management. These results were confirmed on univariate Cox regression, but not multivariate regression (OR 0.773 (0.526 to 1.136); p=0.19). Both Kaplan-Meier survival and regression analyses showed that dual antiplatelet therapy (DAPT) and anticoagulation were not associated with significant improvement in MACCE rates.ConclusionOur analysis showed similar long-term MACCE risks in patients with CAA undergoing medical, percutaneous and surgical management. Further, DAPT and anticoagulation were not associated with significant benefits in terms of MACCE rates. These results should be interpreted with caution considering the small size and potential for selection bias and should be confirmed in large, randomised trials.

scholarly journals The Role of Hydraulic Silicate Cements on Long-Term Properties and Biocompatibility of Partial Pulpotomy in Permanent Teeth

Materials ◽  
2021 ◽  
Vol 14 (2) ◽  
pp. 305
Author(s):  
Chung-Min Kang ◽  
Saemi Seong ◽  
Je Seon Song ◽  
Yooseok Shin
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Antimicrobial Properties ◽  
Permanent Teeth ◽  
Success Rates ◽  
Pulp Tissue ◽  
Cox Regression Analysis ◽  
Clinical Variables

The use of hydraulic silicate cements (HSCs) for vital pulp therapy has been found to release calcium and hydroxyl ions promoting pulp tissue healing and mineralized tissue formation. The present study investigated whether HSCs such as mineral trioxide aggregate (MTA) affect their biological and antimicrobial properties when used as long-term pulp protection materials. The effect of variables on treatment outcomes of three HSCs (ProRoot MTA, OrthoMTA, and RetroMTA) was evaluated clinically and radiographically over a 48–78 month follow-up period. Survival analysis was performed using Kaplan–Meier survival curves. Fisher’s exact test and Cox regression analysis were used to determine hazard ratios of clinical variables. The overall success rate of MTA partial pulpotomy was 89.3%; Cumulative success rates of the three HSCs were not statistically different when analyzed by Cox proportional hazard regression analysis. None of the investigated clinical variables affected success rates significantly. These HSCs showed favorable biocompatibility and antimicrobial properties in partial pulpotomy of permanent teeth in long-term follow-up, with no statistical differences between clinical factors.

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