scholarly journals Single versus bilateral mammary artery grafts in the setting of off-pump coronary revascularization: Survival benefit with bilateral mammary

2021 ◽  
Author(s):  
Ana Lopez-Marco ◽  
Aidil Syed ◽  
Mabel Phillips Bn ◽  
Jennifer Williams ◽  
John Hogan Phd ◽  
...  
Keyword(s):  
Wound Infection ◽  
Survival Benefit ◽  
Long Term Results ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Term Survival ◽  
Off Pump ◽  
Mammary Arteries ◽  
Single Versus

OBJECTIVE To compare postoperative and long-term results (angina, myocardial and cerebrovascular events and coronary re-intervention) using single versus bilateral internal mammary arteries (SIMA vs. BIMA) in the setting of off-pump revascularisation (OPCAB) within a single-surgeon practice. METHODS Retrospective analysis of all isolated OPCAB performed in our institution by a single surgeon in the last 12 years.Two groups were analysed: SIMA (n = 681) and BIMA (n = 342). A propensity score matching was performed to compare the groups, reducing the sample to 684 patients.Follow-up (mean 6.5 ± 3.5 years) was done by telephone interviews or clinical visits, registering also late mortality and coronary re-intervention. Outcomes were compared to literature. RESULTS Demographic characteristics differed between groups, with BIMA offered predominantly to non-diabetic younger males (mean 59.4 years) with less comorbidity. In-hospital mortality was 2% for the SIMA group and 1% for BIMA (p = 0.18). Long-term mortality was also higher for the SIMA group (2% vs. 1% at 1 year, p = 0.22 and 16% vs. 5% at 5 years, p < 0.001). Sternal wound infection was similar in both groups (2-3%). Long-term follow-up revealed good freedom from angina (94%) with low rates of neurological and myocardial events (3%) or need for repeated revascularisation (3%) in both groups. CONCLUSION BIMA offers long-term survival benefit with similar postoperative complications. Rates of deep sternal wound infection were comparable between the two groups.Excellent outcomes can be achieved with OPCAB BIMA in real world practice with adequate patient selection.

The Impact of Deep Sternal Wound Infection on Long-term Survival After Coronary Artery Bypass Grafting

CHEST Journal ◽  
2005 ◽  
Vol 127 (2) ◽  
pp. 464-471 ◽  
Author(s):  
Ioannis K. Toumpoulis ◽  
Constantine E. Anagnostopoulos ◽  
Joseph J. DeRose ◽  
Daniel G. Swistel
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Wound Infection ◽  
Artery Bypass ◽  
Deep Sternal Wound Infection ◽  
Bypass Grafting ◽  
Sternal Wound Infection ◽  
Term Survival ◽  
The Impact

scholarly journals Deep sternal wound infection requiring revision surgery: impact on mid-term survival following cardiac surgery☆

2008 ◽  
Vol 33 (4) ◽  
pp. 673-678 ◽  
Author(s):  
Anand Sachithanandan ◽  
Prakash Nanjaiah ◽  
Peter Nightingale ◽  
Ian C. Wilson ◽  
Timothy R. Graham ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Wound Infection ◽  
Revision Surgery ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Term Survival

Incidence of Deep Sternal Wound Infection in Diabetic Patients Undergoing Off-Pump Skeletonized Internal Thoracic Artery Grafting

Cardiology ◽  
2015 ◽  
Vol 133 (2) ◽  
pp. 111-118 ◽  
Author(s):  
Wen Jun Ding ◽  
Qiang Ji ◽  
Yun Qing Shi ◽  
Run Hua Ma ◽  
Chun Sheng Wang
Keyword(s):  
Wound Infection ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Multivariate Logistic Regression Analysis ◽  
Diabetic Patients ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Off Pump ◽  
Opcab Surgery ◽  
The Impact

Objectives: To evaluate the impact of skeletonized bilateral or single internal thoracic artery (ITA) grafting on the risk of deep sternal wound infection (DSWI) in diabetic patients undergoing off-pump coronary artery bypass grafting (OPCAB). Materials and Methods: A total of 803 diabetic patients undergoing OPCAB surgery from January 2010 to December 2014 were enrolled into this study and assigned to the pSITA group (patients undergoing pedicled single ITA grafting, n = 362), the sSITA group (skeletonized single ITA grafting, n = 295), or the sBITA group (skeletonized bilateral ITA grafting, n = 146). The primary end point was the diagnosis of a DSWI. Results: Eighteen patients developed postoperative DSWI, with an incidence of 2.2%. Patients in the sSITA group had a significantly lower incidence of DSWI than those in the pSITA group (1.0 vs. 3.6%, p = 0.0408). In multivariate logistic regression analysis, the risk of DSWI in the sSITA group was 0.41 times that in the pSITA group. Conclusions: sSITA grafting lowered the risk of DSWI in diabetic patients undergoing OPCAB surgery compared to pSITA grafting. Multicenter clinical trials involving larger sample sizes are needed to determine the merit of pSITA grafting in reducing the risk of DSWI following OPCAB surgery.

scholarly journals Long term mortality of deep sternal wound infection after coronary artery bypass surgery

2012 ◽  
Vol 27 (3) ◽  
pp. 377-382 ◽  
Author(s):  
Aline Alexandra Iannoni de Moraes ◽  
Cely Saad Abboud ◽  
André Zeraik Limma Chammas ◽  
Yara Santos Aguiar ◽  
Lucas Cronemberger Mendes ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Wound Infection ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Long Term Mortality

scholarly journals Bilateral internal thoracic artery versus single internal thoracic artery: a meta-analysis of propensity score-matched observational studies

2019 ◽  
Vol 29 (2) ◽  
pp. 163-172 ◽  
Author(s):  
Stefano Urso ◽  
Eliú Nogales ◽  
Jesús María González ◽  
Rafael Sadaba ◽  
María Ángeles Tena ◽  
...  
Keyword(s):  
Propensity Score ◽  
Wound Infection ◽  
Risk Ratio ◽  
Internal Thoracic Artery ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Deep Sternal Wound Infection ◽  
Term Survival ◽  
Long Term Survival

Abstract The lack of benefit in terms of mid-term survival and the increase in the risk of sternal wound complications published in a recent randomized controlled trial have raised concerns about the use of bilateral internal thoracic artery (BITA) in myocardial revascularization surgery. For this reason, we decided to explore the current evidence available on the subject by carrying out a meta-analysis of propensity score-matched studies comparing BITA versus single internal thoracic artery (SITA). PubMed, EMBASE and Google Scholar were searched for propensity score-matched studies comparing BITA versus SITA. The generic inverse variance method was used to compute the combined hazard ratio (HR) of long-term mortality. The DerSimonian and Laird method was used to compute the combined risk ratio of 30-day mortality, deep sternal wound infection and reoperation for bleeding. Forty-five BITA versus SITA matched populations were included. Meta-analysis showed a significant benefit in terms of long-term survival in favour of the BITA group [HR 0.78; 95% confidence interval (CI) 0.71–0.86]. These results were consistent with those obtained by a pooled analysis of the matched populations comprising patients with diabetes (HR 0.65; 95% CI 0.43–0.99). When compared with the use of SITA plus radial artery, BITA did not show any significant benefit in terms of long-term survival (HR 0.86; 95% CI 0.69–1.07). No differences between BITA and SITA groups were detected in terms of 30-day mortality or in terms of reoperation for bleeding. Compared with the SITA group, patients in the BITA group had a significantly higher risk of deep sternal wound infection (risk ratio 1.66; 95% CI 1.41–1.95) even when the pooled analysis was limited to matched populations in which BITA was harvested according to the skeletonization technique (risk ratio 1.37; 95% CI 1.04–1.79). The use of BITA provided a long-term survival benefit compared with the use of SITA at the expense of a higher risk of sternal deep wound infection. The long-term survival advantage of BITA is undetectable when compared with SITA plus radial artery.

Short- and long-term mortality after deep sternal wound infection following cardiac surgery: experiences from SWEDEHEART

2021 ◽  
Author(s):  
Alexander Emil Kaspersen ◽  
Susanne J Nielsen ◽  
Andri Wilberg Orrason ◽  
Astridur Petursdottir ◽  
Martin Ingi Sigurdsson ◽  
...  
Keyword(s):  
Wound Infection ◽  
Valve Surgery ◽  
Absolute Difference ◽  
Deep Sternal Wound Infection ◽  
Adjusted Relative Risk ◽  
Sternal Wound Infection ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
Long Term Mortality

Abstract Graphical Abstract OBJECTIVES Deep sternal wound infection (DSWI) is a serious complication after open-heart surgery. We investigated the association between DSWI and short- and long-term all-cause mortality in a large well-defined nationwide population. METHODS A retrospective, nationwide cohort study, which included 114 676 consecutive patients who underwent coronary artery bypass grafting (CABG) and/or valve surgery from 1997 to 2015 in Sweden. Short- and long-term mortality was compared between DSWI patients and non-DSWI patients using propensity score inverse probability weighting adjustment based on patient characteristics and comorbidities. Median follow-up was 8.0 years (range 0–18.9). RESULTS Altogether, 1516 patients (1.3%) developed DSWI, most commonly in patients undergoing combined CABG and valve surgery (2.1%). DSWI patients were older and had more disease burden than non-DSWI patients. The unadjusted cumulative mortality was higher in the DSWI group compared with the non-DSWI group at 90 days (7.9% vs 3.0%, P &lt; 0.001) and at 1 year (12.8% vs 4.5%, P &lt; 0.001). The adjusted absolute difference in risk of death was 2.3% [95% confidence interval (CI): 0.8–3.9] at 90 days and 4.7% (95% CI: 2.6–6.7) at 1 year. DSWI was independently associated with 90-day [adjusted relative risk (aRR) 1.89 (95% CI: 1.38–2.59)], 1-year [aRR 2.13 (95% CI: 1.68–2.71)] and long-term all-cause mortality [adjusted hazard ratio 1.56 (95% CI: 1.30–1.88)]. CONCLUSIONS Both short- and long-term mortality risks are higher in DSWI patients compared to non-DSWI patients. These results stress the importance of preventing these infections and careful postoperative monitoring of DSWI patients.

Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 474-481 ◽  
Author(s):  
Radak ◽  
Babic ◽  
Ilijevski ◽  
Jocic ◽  
Aleksic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Limb Salvage ◽  
Iliac Artery ◽  
Graft Patency ◽  
Long Term Results ◽  
Surgical Reconstruction ◽  
Safe Procedure ◽  
Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

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