Bilateral internal thoracic artery grafting: Long-term clinical and angiographic results of in situ versus Y grafts

Calafiore, Antonio M.; Contini, Marco; Vitolla, Giuseppe; Mauro, Michele Di; Mazzei, Valerio; Teodori, Giovanni; Giammarco, Gabriele Di

doi:10.1067/mtc.2000.110249

Cited by 174 publications

(133 citation statements)

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“…In practice, several configurations, including Y graft, free graft, and in situ configuration, are all associated with excellent patency rates. [43][44][45] Fourth, there may be little difference between the effects of the two techniques on clinical outcomes, owing to better long-term vein-graft patency, asymptomatic vein-graft failure, and improved medical therapy.…”

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts

et al. 2016

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med nejm.org BACKGROUNDThe use of bilateral internal thoracic (mammary) arteries for coronary-artery bypass grafting (CABG) may improve long-term outcomes as compared with the use of a single internal-thoracic-artery plus vein grafts. METHODSWe randomly assigned patients scheduled for CABG to undergo single or bilateral internal-thoracic-artery grafting in 28 cardiac surgical centers in seven countries. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome. Interim analyses were prespecified at 5 years of follow-up. RESULTSA total of 3102 patients were enrolled; 1554 were randomly assigned to undergo single internal-thoracic-artery grafting (the single-graft group) and 1548 to undergo bilateral internal-thoracic-artery grafting (the bilateral-graft group). At 5 years of follow-up, the rate of death was 8.7% in the bilateral-graft group and 8.4% in the single-graft group (hazard ratio, 1.04; 95% confidence interval [CI], 0.81 to 1.32; P = 0.77), and the rate of the composite of death from any cause, myocardial infarction, or stroke was 12.2% and 12.7%, respectively (hazard ratio, 0.96; 95% CI, 0.79 to 1.17; P = 0.69). The rate of sternal wound complication was 3.5% in the bilateralgraft group versus 1.9% in the single-graft group (P = 0.005), and the rate of sternal reconstruction was 1.9% versus 0.6% (P = 0.002). CONCLUSIONSAmong patients undergoing CABG, there was no significant difference between those receiving single internal-thoracic-artery grafts and those receiving bilateral internal-thoracic-artery grafts with regard to mortality or the rates of cardiovascular events at 5 years of follow-up. There were more sternal wound complications with bilateral internal-thoracic-artery grafting than with single internal-thoracicartery grafting. Ten-year follow-up is ongoing. (Funded by the British Heart Foundation and others; ART Current Controlled Trials number, ISRCTN46552265.)

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Section: Discussionmentioning

confidence: 99%

Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts

et al. 2016

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“…Indeed, only a few authors have reported the comparison between the 2 types of BITA assemblages, and these studies were all retrospective. Calafiore and al 15 reported a series of 1818 patients who received BITA (76% BITA in situ versus 24% BITA Y) with a mean clinical follow-up of 33 months. An angiographic control was available in only 5% of the patients at a mean follow-up time of 17 months.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Bilateral Internal Thoracic Artery Revascularization Using In Situ or Y Graft Configurations

Glineur¹,

Hanet²,

Poncelet³

et al. 2008

Circulation

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Background-Bilateral internal thoracic arteries (BITA) demonstrated superiority over other grafts to the left coronary system in terms of patency and survival benefit. Several BITA configurations are proposed for left-sided myocardial revascularization, but the ideal BITA assemblage is still unidentified. Methods and Results-From 03/2003 to 08/2006, 1297 consecutive patients underwent isolated bypass surgery in our institution. 481 patients met the inclusion criteria for randomization, and 304 (64%) were randomized. Patients were allocated to BITA in situ grafting (nϭ147) or Y configuration (nϭ152) then evaluated for clinical, functional, and angiographic outcome after 6 months and 3 years. Patient telephone interviews were conducted every 3 months and a stress test performed twice yearly under the referring cardiologist's supervision. Angiographic follow-up was performed 6 months after surgery. The primary and secondary end points were, respectively, major adverse cerebrocardiovascular events (MACCE) and the proportion of ITA grafts that were completely occluded at follow-up angiography. More arterial anastomoses were performed in patients randomized to the Y than the in situ configuration (3.2 versus 2.4; PϽ0.001). No significant difference between the 2 groups in terms of hospital mortality or morbidity was found. At follow-up, there was no significant difference in any MACCE rate between the 2 groups. 450 out of 464 anastomosis (97%) in the BITA Y group and 287 of 295 (97%) in the BITA in situ group were controlled patent (Pϭ0.99). Conclusion-Excellent patency rates were achieved using both BITA configurations with no significant differences in terms of MACCE up to 19 months postoperatively, but longer-term results remain to be established.

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“…La revascularización con AMI de otras arterias diferentes de la DA, de arterias con estenosis inferiores al 60%, o el uso de la AMI derecha como bypass aortocoronario en lugar de como injerto in situ reducen la permeabilidad de la AMI; los resultados son similares a los de la vena safena [41][42][43] . La reserva adecuada de flujo con la AMI derecha anastomosada en Y a la AMI izquierda queda corroborada por excelentes resultados clínicos de flujo y permeabilidad 44,45 . La extensión del injerto es también una técnica segura con una permeabilidad mayor del 95% 46 , así como las anastomosis secuenciales, excepto cuando se revascularizan ramas marginales de la arteria circunfleja o distales de la arteria coronaria derecha 47 .…”

Section: Tipo De Injertounclassified

“…La extensión del injerto es también una técnica segura con una permeabilidad mayor del 95% 46 , así como las anastomosis secuenciales, excepto cuando se revascularizan ramas marginales de la arteria circunfleja o distales de la arteria coronaria derecha 47 . El uso de las dos AMI, sin incrementar la mortalidad hospitalaria, mejora la supervivencia a largo plazo y reduce la prevalencia de reintervenciones 22,36,37,41,45 ; estas diferencias a favor de la doble AMI son mayores en los pacientes de edad avanzada con múltiples factores de riesgo que en los pacientes jóve-nes, durante los primeros 10 años postoperatorios 41 . Las reticencias al uso de la doble AMI en pacientes diabéticos ha quedado solventada con la disección de la AMI «esqueletizada» 48 .…”

Section: Tipo De Injertounclassified

Cirugía coronaria. Evolución en la última década. Indicaciones y resultados actuales

Herreros

2005

Revista Española de Cardiología

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La cirugía coronaria está avalada por unos excelentes resultados, bien documentados a largo plazo como consecuencia de la revascularización completa y la utilización de una o 2 arterias mamarias. En este artículo se revisan los resultados y las indicaciones de la cirugía y se valoran los nuevos retos y las oportunidades que incluyen la cirugía más segura, menos agresiva y asociada a otros procedimientos quirúrgicos. El objetivo es desarrollar estrategias ligadas a un ciclo innovador que adapte la cirugía a las necesidades de la población, las nuevas tecnologías y a las actividades pioneras. INTRODUCCIÓNLa cirugía coronaria tiene un origen incierto, en función de la localización geográfica y las preferencias del autor: Senning en Europa (1966), Garrett (1996) Coronary artery bypass surgery is endorsed by the excellent, well-documented, long-term results that follow complete revascularization and the use of 1 or 2 mammary artery grafts. This article contains a review of the current indications for and the results of such surgery and an evaluation of new challenges and opportunities, including the implementation of safer and less aggressive surgery, and surgery associated with other operative procedures. The aim was to develop a strategy linked to a cycle of innovation that could be used to adapt surgery to the needs of the population, to new technologies, and to pioneering developments.

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Bilateral internal thoracic artery grafting: Long-term clinical and angiographic results of in situ versus Y grafts

Cited by 174 publications

References 18 publications

Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts

Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts

Comparison of Bilateral Internal Thoracic Artery Revascularization Using In Situ or Y Graft Configurations

Cirugía coronaria. Evolución en la última década. Indicaciones y resultados actuales

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