Bilateral Internal Thoracic Artery Grafting in Women: A Word of Caution

Autor: Thibaut Schoell, Guillaume Lebreton, Laurent Genser, Marina Clément, Julien Amour, Reza Tavakoli, Pascal Leprince
Přispěvatelé: Service de Chirurgie cardiaque et thoracique [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de Chirurgie Digestive, Hépato-Bilio-pancréatique et Transplantation Hépatique [CHU Pitié-Salpétrière], Service d'Anesthésie réanimation [CHU Pitié-Salpêtrière]
Rok vydání: 2018
Předmět:
medicine.medical_specialty
[SDV]Life Sciences [q-bio]
medicine.medical_treatment
Hemodynamics
Internal thoracic artery
Coronary Artery Disease
030204 cardiovascular system & hematology
Revascularization
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
medicine.artery
Hemofiltration
medicine
Humans
Myocardial infarction
Hospital Mortality
Mammary Arteries
Stroke
Internal Mammary-Coronary Artery Anastomosis
Aged
Retrospective Studies
business.industry
Incidence (epidemiology)
Incidence
Retrospective cohort study
030229 sport sciences
General Medicine
Middle Aged
medicine.disease
3. Good health
Surgery
Female
France
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Zdroj: heart surgery forum
heart surgery forum, Forum Multimedia Publishing, 2019, 22 (1), pp.E045-E049. ⟨10.1532/hsf.2067⟩
ISSN: 1522-6662
1098-3511
DOI: 10.1532/hsf.2067⟩
Popis: Background: Despite the superior hemodynamic performance of internal thoracic arteries, total arterial revascularization with exclusive bilateral internal thoracic arteries (BITA) is less frequently used especially in specific subsets of patients, including females. We report our experience with total arterial revascularization with exclusive BITA regardless of sex and analyze the impact of female sex on the early and midterm outcomes. Methods: Total arterial revascularization with exclusive BITA was performed with equal frequency in females (79/99, 80%) and males (392/477, 82%; P = .68) undergoing isolated CABG for 3-vessel disease. Pre, intra and postoperative data were compared between these two groups. Results: Complete revascularization was achieved in 77% of females and 72% of males (P = .08). Early mortality did not differ between the groups (6.3% versus 4.6%, P = .7). The incidence of re-sternotomy for bleeding, postoperative stroke, myocardial infarction, new onset atrial fibrillation, and hemofiltration for renal failure did not differ between the two groups. However, there were significantly more wound revision for combined superficial and deep sternal wound infection in females (26.5% versus 5.1%, P = .0001). Nevertheless, midterm survival, freedom from repeat revascularization, myocardial infarction, stroke, and major adverse cardiovascular and cerebral events at five years were very good and compared favorably between females and males. Conclusions: Our findings suggest that total arterial myocardial revascularization with exclusive internal thoracic arteries in females carries the same midterm benefits as in males. Early outcomes are comparable except for a higher incidence of wound revision for combined superficial and deep sternal wound infections in females compared to males. Benefits of bilateral internal thoracic artery grafting in females should be weighed against increased risk of early wound revision.
Databáze: OpenAIRE
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