Single versus bilateral internal thoracic artery grafts with concomitant saphenous vein grafts for multivessel coronary artery bypass grafting: effects on mortality and event-free survival
| Autor: | Annik Fortier, Michel Carrier, Denis Bouchard, Yves Hébert, Michel Pellerin, Louis-Mathieu Stevens, Raymond Cartier, Ismail El-Hamamsy, Louis P. Perrault |
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| Jazyk: | angličtina |
| Předmět: |
Thorax
Pulmonary and Respiratory Medicine Male Reoperation medicine.medical_specialty education Internal thoracic artery Disease-Free Survival Postoperative Complications medicine.artery Internal medicine Medicine Humans Saphenous Vein Derivation Coronary Artery Bypass Mammary Arteries Vein Coronary Vein business.industry Unstable angina Middle Aged medicine.disease Surgery Survival Rate medicine.anatomical_structure Treatment Outcome surgical procedures operative Circulatory system Multivariate Analysis Cardiology Female business Cardiology and Cardiovascular Medicine Artery |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. (5):1408-1415 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2003.10.006 |
| Popis: | BackgroundThe issue of superiority of single internal thoracic artery grafting versus bilateral internal thoracic artery grafting remains unresolved. The aim of this study was to compare the long-term outcome of single and bilateral internal thoracic artery grafting with concomitant saphenous vein grafting for multivessel coronary artery bypass grafting.MethodsBetween March 1985 and April 1995, 6650 patients underwent primary isolated coronary artery bypass grafting with internal thoracic artery grafts, including 4382 patients with multivessel bypass grafting requiring at least 3 grafts. Outcomes of patients undergoing single internal thoracic artery plus saphenous vein grafting (n = 2547) and bilateral internal thoracic artery plus saphenous vein grafting (n = 1835) were obtained at a mean follow-up of 11 ± 3 years.ResultsPatients with bilateral internal thoracic artery grafting were younger, were mostly male, and had less diabetes, hypertension, unstable angina, and recent myocardial infarction than patients undergoing single internal thoracic artery grafting. Thirty-day mortality was 2.3% for the group undergoing single internal thoracic artery grafting versus 1.2% for those undergoing bilateral internal thoracic artery grafting (P = .007). Survival probability at 10 years was 88% for the single-graft group compared with 93% for the bilateral-graft group (P < .001). Multivariate analysis with propensity scoring showed that bilateral internal thoracic artery grafting decreased the risk of death (hazard ratio, 0.74; 95% confidence interval, 0.60-0.90), myocardial infarction (hazard ratio, 0.79; 95% confidence interval, 0.67-0.93), and coronary reoperation (hazard ratio, 0.41; 95% confidence interval, 0.21-0.80) throughout the follow-up period. Other significant predictors of death were diabetes, prior myocardial infarction, need for intra-aortic balloon pump, chronic heart failure, and peripheral vascular disease.ConclusionPatients undergoing bilateral internal thoracic plus saphenous vein grafting appear to have a significantly better long-term clinical outcome than patients undergoing single internal thoracic artery plus saphenous vein grafting for multivessel coronary artery bypass grafting. |
| Databáze: | OpenAIRE |
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