Bilateral internal thoracic arteries

In an attempt to obtain more robust scientific evidence as to whether bilateral internal thoracic artery grafting offers a survival benefit over single internal thoracic artery grafting, the Arterial Revascularisation Trial (ART) enrolled 3102 patients between June 2014 and December 2017 in 28 centres in seven countries. The primary outcome was all-cause mortality at 10 years and the secondary outcome a composite of death, myocardial infarction, and stroke. This chapter describes the implications of the 10-year outcomes of ART.

Arterial revascularisation using in situ or Y-composite conduits of internal thoracic arteries: Early results

<em><em></em></em><strong>Aim.</strong> This study aimed to research the early results of arterial revascularisation using <em>in situ</em>or Y-composite conduits of internal thoracic arteries.<p><strong>Methods.</strong> The study included 76 patients with coronary heart disease who underwent coronary artery bypass surgery between March 2018 and March 2020. Two groups of patients were selected. In the first group, autoarterial conduits from the internal thoracic arteries were used according to the <em>in situ</em> technique (n = 39). In the second group, autoarterial conduits were used with the formation of a Y-composite structure from the internal thoracic arteries (n = 37).</p><p><strong>Results.</strong> The general characteristics and frequency of postoperative complications for most events were comparable in both groups. The usage of on-pump coronary artery bypass graft was significantly more frequent in the <em>in situ</em> group than in the Y-composite group (28.2 and 3.0 %, respectively; p &lt; 0.003). The duration of inotropic support was significantly shorter in the <em>in situ</em> group and was 3.72 ± 8.60 hours versus 8.0 ± 9.6 hours in the Y-composite group (p &lt; 0.007). No significant difference was found between the main adverse cardiac and cerebral events throughout the hospital follow-up period.</p><p><strong>Conclusion.</strong> The low incidence of perioperative complications, the absence of perioperative myocardial infarction and the low hospital mortality indicate that bilateral mammary coronary bypass surgery is safe. Despite the absence of differences in the early postoperative period, we expect that in the long-term period there will be a statistically significant difference in major adverse cardiac events between Y-composite structures and <em>in situ</em> conduits from internal thoracic arteries.</p><p>Received 23 June 2020. Revised 14 September 2020. Accepted 1 October 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: A.K. Sabetov<br />Data collection and analysis: A.K. Sabetov, M.O. Zhulkov<br />Statistical analysis: D.S. Khvan, A.K. Sabetov<br />Drafting the article: A.K. Sabetov<br />Critical revision of the article: D.A. Sirota, D.S. Khvan, A.M. Chernyavskiy<br />Final approval of the version to be published: A.K. Sabetov, D.A. Sirota, D.S. Khvan, M.O. Zhulkov, A.M. Chernyavskiy</p>

Effects of diabetes and obesity in patients undergoing coronary artery bypass graft surgery: ten-year results from the Arterial Revascularisation Trial

Background Coronary artery bypass graft (CABG) surgery is an effective way to manage advanced coronary heart disease. Diabetes is associated with higher risk of mortality in patients undergoing CABG but the effects of obesity, and the interactions between diabetes and obesity in the context of CABG, have not been fully explored. Methods The Arterial Revascularisation Trial (ART) compared ten-year mortality in patients undergoing CABG randomised to single or bilateral internal thoracic arterial grafts. Effects of diabetes and obesity on mortality and risk (sternal wound complications) were explored. Diabetes was defined according to clinical history at baseline and combined insulin and non-insulin dependent patients, and obesity was defined as body mass index (BMI) ≥30kg/m2 at baseline. Results Information on diabetes, obesity and ten-year mortality were documented for 3094 patients who were included in the analysis. Mean age was 64 years, 86% male, mean weight 82kg and BMI 28. Diabetes was documented in 24% and obesity in 30% and as expected obese patients were more likely to be diabetic. The hazard ratios (95% confidence intervals) for ten-year mortality using the no diabetes, non-obese group as a reference were 1.33 (1.08, 1.64) (diabetes, non-obese), 0.93 (0.75, 1.16) (no diabetes, obese) and 1.18 (0.91, 1.54) (diabetes, obese) groups (Figure 1). Similar patterns of risk were observed whether patients were randomised to receive single or bilateral internal thoracic arteries and diabetes appeared to be the main driver of elevated risk of early sternal wound complications following CABG. Conclusions Obesity and diabetes are closely associated but our analysis shows that patterns of risk of death after CABG are not additive for these characteristics, and obesity may actually be associated with lower death rates in patients with and without diabetes. These findings will be explored further to understand mechanisms and interactions with other factors. Figure 1. Hazard ratios at 10 years Funding Acknowledgement Type of funding source: None