Comparison of radial and bilateral internal thoracic artery grafting in patients with peripheral vascular disease†
| Autor: | Dmitry Pevni, Nahum Nesher, Nadav Teich, Zvi Raviv, Yanai Ben-Gal, Benjamin Medalion, Yosef Paz, Rephael Mohr, Amir Kramer |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Coronary Artery Disease Internal thoracic artery 030204 cardiovascular system & hematology Revascularization 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine.artery medicine Humans Mammary Arteries Radial artery Propensity Score Internal Mammary-Coronary Artery Anastomosis Aged Proportional Hazards Models Peripheral Vascular Diseases Proportional hazards model business.industry Vascular disease Unstable angina Hazard ratio medicine.disease Surgery 030228 respiratory system Radial Artery Propensity score matching Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Interactive CardioVascular and Thoracic Surgery. 24:911-917 |
| ISSN: | 1569-9285 1569-9293 |
| DOI: | 10.1093/icvts/ivw449 |
| Popis: | Objectives The composite T-graft with radial artery (RA) attached end-to-side to the left internal thoracic artery (ITA) provides arterial myocardial revascularization without the increased risk of deep sternal wound infection associated with harvesting 2 ITAs. However, many surgeons are reluctant to use RA in patients with peripheral vascular disease (PVD) due to concerns regarding the quality of the conduit in this subset of patients. The purpose of this study is to compare early- and long-term outcomes of arterial grafting with bilateral ITAs (BITA) to that of single ITA and RA in patients with PVD. Methods Between 1999 and 2010, 619 consecutive patients with PVD (500 BITAs and 119 single ITA and RA) underwent myocardial revascularization in our institution. Results Occurrence of following risk factors as female sex, age 70+, diabetes, unstable angina, emergency operation, cerebrovascular disease and chronic obstructive pulmonary disease was higher in the RA-ITA group. The RA-ITA group also had a higher logistic EuroSCORE (22.1 vs 13.3). Operative mortality and occurrence of deep sternal wound infection of the two groups was similar (4.2% vs 5.0% and 2.5% vs 4.0% for the radial and bilateral ITA, respectively). Median follow-up was 9.75 years. Unadjusted Kaplan-Meier 10-year survival of the two groups was similar (44.1% vs 49.6%, P = 0.7). After propensity score matching (100 pairs), assignment to BITA was not associated with better adjusted survival (hazard ratio 0.593, 95% confidence interval 0.265-1.327, P = 0.20, Cox model). Conclusions In patients with PVD, complete arterial revascularization with left ITA and RA can be justified with regards to survival. |
| Databáze: | OpenAIRE |
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