Bilateral Internal Thoracic Artery Configuration for Coronary Artery Bypass Surgery

Glineur, David; Boodhwani, Munir; Hanet, Claude; Kerchove, Laurent de; Navarra, Emiliano; Astarci, Parla; Noirhomme, Philippe; Khoury, Gébrine El

doi:10.1161/circinterventions.115.003518

Cited by 44 publications

(29 citation statements)

References 18 publications

(21 reference statements)

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“…It has been shown that an increase in the number of BITA anastomoses is associated with better clinical outcome. 49 For DSWI, the adoption of the skeletonized technique for harvesting was similar between high and low BITA users (42.9% in the first quartile and 57.1% in the fourth quartile; P=0.56), and the association between the OR for DSWI and % BITA was confirmed, even in the multivariable meta-regression model after adjusting for skeletonization. These results suggest that BITA skeletonization alone is not the explanation for the reported difference in DWSI.…”

Section: Discussionmentioning

confidence: 75%

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Use Rate and Outcome in Bilateral Internal Thoracic Artery Grafting: Insights From a Systematic Review and Meta‐Analysis

Gaudino

Bakaeen

Benedetto

et al. 2018

JAHA

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BackgroundThis meta‐analysis was designed to assess whether center experience affects the short‐ and long‐term results and the relative benefits of bilateral internal thoracic artery grafting (BITA) for coronary artery bypass grafting.Methods and ResultsMEDLINE and EMBASE were searched to identify all articles reporting the outcome of BITA in patients undergoing coronary artery bypass grafting. The BITA center experience was gauged according to the percentage use of BITA in the institutional overall coronary artery bypass grafting population (%BITA). The primary outcome was long‐term all‐cause mortality. Secondary outcomes were operative mortality, perioperative myocardial infarction, perioperative stroke, deep sternal wound infections (DSWIs), and major postoperative adverse event. The rates of the primary and secondary outcomes were calculated after adjusting for %BITA. Primary and secondary outcomes were also compared between the BITA and the single internal thoracic artery arms in the adjusted studies. Meta‐regression was used to evaluate the effect of %BITA on the primary and secondary outcomes. Thirty‐four studies (27 894 patients undergoing BITA) were included. In the pooled analysis, the incidence rate for long‐term mortality was 2.83% (95% confidence interval, 2.21%–3.61%). %BITA was significantly and inversely associated with long‐term mortality and the rate of DSWI. In the pairwise comparison, %BITA was significantly and inversely associated with the risk of long‐term mortality and DSWI in the group undergoing BITA.ConclusionsBITA series with higher %BITA report significantly lower long‐term mortality and DSWI rate as well as higher long‐term survival advantage and lower relative risk of DSWI in their BITA cohort. These findings suggest that a specific volume‐outcome relationship exists for BITA grafting.

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Section: Discussionmentioning

confidence: 75%

“…It is notable that 67% of the studies in the highest quartile of %BITA versus 38% in the lowest quartile used BITA sequentials ( P =0.03). It has been shown that an increase in the number of BITA anastomoses is associated with better clinical outcome …”

Section: Discussionmentioning

confidence: 99%

Use Rate and Outcome in Bilateral Internal Thoracic Artery Grafting: Insights From a Systematic Review and Meta‐Analysis

Gaudino

Bakaeen

Benedetto

et al. 2018

JAHA

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“…Glineur et al performed a prospective randomized trial that showed that the graft patency of BIMA grafts was similar between in-situ and Y-grafting coniguration, whereas the use of BIMA in a Y-grafting coniguration was associated in lower rates of major adverse cardiovascular and cerebrovascular events [45].…”

Section: Rationale For Bima Usementioning

confidence: 99%

The Choice of Graft Conduits in Coronary Artery Bypass Grafting

Murashita¹

2017

Coronary Artery Bypass Graft Surgery

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The use of the left internal mammary artery (IMA) has been shown to improve longterm survival and has been a gold standard in coronary artery bypass grafting (CABG). However, the choice of second or third graft conduit is still controversial. Multiple studies demonstrated the beneit of using multiple arterial grafts such as right IMA and radial artery in addition to left IMA in terms of long-term survival and graft patency. However, most of the centers still perform CABG with one IMA and vein grafts in a real world. The challenges for bilateral IMA utilization include longer operative time and concerns for higher rates of perioperative morbidity and mortality associated with increased sternal wound infection. Several studies reported that skeletonization technique can reduce the risk of sternal wound infection. Radial artery is another arterial conduit, which does not increase the risk of sternal wound infection and is easy to harvest. The superiority between radial artery and right IMA has been controversial. In the meantime, multiple trials have been made to improve the patency of vein grafts. The choice of graft conduits in CABG should be well considered preoperatively based on each patient's backgrounds.

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“…In a recent prospective, randomized clinical trial, Glineur and colleagues 6 showed that the clinical benefit of the bilateral internal thoracic artery composite Y configuration seems independent of the quality of revascularization provided by the internal thoracic artery graft itself, but rather is related to the poor long-term outcome of the third complementary graft, more frequently needed with the in situ bilateral internal thoracic artery configuration. This implies that the quality of surgical revascularization could be optimized either by decreasing the number of coronary arteries that require a complementary third graft or by using as complementary third graft a conduit of superior quality.…”

mentioning

confidence: 99%

“…Composite bilateral internal thoracic artery grafting resulted in significant lower rates of major adverse cardiac and cerebrovascular events at 7 years than did conventional in situ bilateral internal thoracic artery grafting. 6 If surgical revascularization aims to remain the superior treatment in coronary artery disease, efforts should be made toward a more efficient use of internal thoracic arteries, reduction of the need for a third complementary graft, and identification of the best alternative to SVG as the third graft material for complete revascularization of multivessel disease. 7…”

mentioning

confidence: 99%