Bilateral Internal Thoracic Artery In Situ Versus Y-Composite Graftings: Long-term Outcomes

Sohn, Suk Ho; Lee, Yeiwon; Choi, Jae Woong; Hwang, Ho Young; Kim, Ki Bong

doi:10.1016/j.athoracsur.2019.09.057

Cited by 9 publications

(5 citation statements)

References 20 publications

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“…A meta-analysis found that use of bilateral ITAs as a composite and bilateral in situ graft strategies offer similar clinical outcomes, including a composite of all-cause death, nonfatal myocardial infarction, and repeat revascularization ( 111 ). Recent studies demonstrated that long-term (>10 years) clinical outcomes of bilateral ITA composite grafting were comparable to those of bilateral ITA in situ grafting and also demonstrated that long-term (>10 years) clinical outcomes of other arterial composite grafting using radial or right gastroepiploic artery were comparable to those of bilateral ITA composite grafting ( 112 – 114 ) A recent extended study of the SAVE RITA (SAphenous VEin vs. Right Internal Thoracic Artery as a Y-Composite Graft) trial demonstrated that the vein composite grafts were comparable to the right ITA composite grafts in terms of 10-year conduit occlusion rates and long-term clinical outcomes ( 115 ).…”

Section: Specific Topics Related To Graft Treatmentmentioning

confidence: 99%

Consensus statement—graft treatment in cardiovascular bypass graft surgery

Emmert,

Bonatti,

Caliskan

et al. 2024

Front. Cardiovasc. Med.

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Coronary artery bypass grafting (CABG) is and continues to be the preferred revascularization strategy in patients with multivessel disease. Graft selection has been shown to influence the outcomes following CABG. During the last almost 60 years saphenous vein grafts (SVG) together with the internal mammary artery have become the standard of care for patients undergoing CABG surgery. While there is little doubt about the benefits, the patency rates are constantly under debate. Despite its acknowledged limitations in terms of long-term patency due to intimal hyperplasia, the saphenous vein is still the most often used graft. Although reendothelialization occurs early postoperatively, the process of intimal hyperplasia remains irreversible. This is due in part to the persistence of high shear forces, the chronic localized inflammatory response, and the partial dysfunctionality of the regenerated endothelium. “No-Touch” harvesting techniques, specific storage solutions, pressure controlled graft flushing and external stenting are important and established methods aiming to overcome the process of intimal hyperplasia at different time levels. Still despite the known evidence these methods are not standard everywhere. The use of arterial grafts is another strategy to address the inferior SVG patency rates and to perform CABG with total arterial revascularization. Composite grafting, pharmacological agents as well as latest minimal invasive techniques aim in the same direction. To give guide and set standards all graft related topics for CABG are presented in this expert opinion document on graft treatment.

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Section: Specific Topics Related To Graft Treatmentmentioning

confidence: 99%

Consensus statement—graft treatment in cardiovascular bypass graft surgery

Emmert,

Bonatti,

Caliskan

et al. 2024

Front. Cardiovasc. Med.

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“…наблюдательных, исследований, в которых сообщалось как о данных до "псевдорандомизации" (Propensity-score [18,20], 4 наблюдательных исследования, сопоставленные по шкале предрасположенности, т.е. с "псевдорандомизацией" (Propensity score matching (PSM)) (n=4267) [10,12,14,17], и 4 нескорректированных обсервационных исследования (n=3517) [11,15,16,19] соответствовали критериям включения. РКИ [18,20] не были слепыми, одно из наблюдательных исследований было проспективным [15], а остальные исследования [10-12, 14, 16, 17, 19] были ретроспективными.…”

Section: материал и методыunclassified

“…В этих случаях ПВГА может использоваться как свободный трансплантат и применяться как композитный графт, хирургические аспекты такого шунтирования хорошо описаны в соответствующих руководствах [8,9]. Существуют единичные исследования сравнения бимаммарного коронарного шунтирования (БиМКШ) in situ с композитным шунтированием [10][11][12][13][14][15][16][17][18][19][20].…”

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Systematic review and meta-analysis of <i>in situ</i> versus composite bimammary coronary artery bypass grafting: immediate outcomes and 30-day mortality

Энгиноев¹,

Kondrat'ev²,

Магомедов³

et al. 2021

Russ J Cardiol

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Aim. To compare the immediate outcomes and 30-day mortality of in situ bimammary coronary artery bypass grafting (CABG) using two internal thoracic arteries (ITAs) versus a composite grafting.Material and methods. We searched PubMed, Google Scholar, and Web of Science databases for a period from 1990 to 2020 for studies comparing in situ bimammary CABG versus composite grafts. The PICO search model was used as follows: patient, intervention, comparison, outcomes. The data were derived by two independent researchers and subjected to a meta-analysis using a random effect.Results. A total of 10 studies were selected for this meta-analysis. Of these, there were 2 randomized controlled trials (n=705), 4 observational propensity score matching studies (n=4267) and 4 unadjusted observational studies (n=3517). With both ITA in situ surgery, fewer distal anastomoses are applied (MD=0,23; 95% confidence interval (CI), 0,15-0,32; p<0,001). But there was no significant difference n myocardial ischemia between groups (3 min with 95% CI, -3,23-9,79; p=0,32). There was no significant difference between groups in the incidence of perioperative stroke (hazard ratio (HR)=0,5; 95% CI; 0,63-1,74; p=0,85 ), myocardial infarction (HR=1,1; 95% CI 0,66-1,85; p=0,71), mediastinitis (HR=0,86; 95% CI; 0,62-1,20; p=0,38), resternotomy due to bleeding (HR=1,29; 95% CI, 0,75-2,21; p=0,36), acute renal injury (HR=1,24; 95% CI, 0, 84-1,84; p=0,29), inhospital mortality (HR=1,08; 95% CI, 0,67-1,75; p=0,75) and 30-day mortality (HR=1,19; 95% CI, 0,81-1,75; p=0,38), but the incidence of postoperative atrial fibrillation was significantly lower in the group with both ITA in situ surgery (RR=1,23 with 95% CI 1,04-1,44; p=0,01).Conclusion. With composite bimammary CABG, more distal anastomoses with ITA were applied, while the time of myocardial ischemia did not differ between the groups. We found no significant difference in the incidence of perioperative myocardial infarction, stroke, mediastinitis, acute renal injury, resternotomy due to bleeding, inhospital mortality, and 30-day mortality. But at the same time, the HR for postoperative atrial fibrillation was significantly lower in the group with both ITA in situ surgery.

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“…[9][10][11] Patient's selection bias of nonrandomized study and variation of ITA graft configuration to LCX (i.e., composite ITA, in situ ITA, or free ITA for LCX) were considered to result in variable conclusions. Only few reports of small sample size suggested that in situ ITA and composite ITA showed similar patency and clinical outcomes, [12][13][14] although those reports were about right ITA (RITA).…”

Section: Introductionmentioning

confidence: 99%

Bypass Grafting to Circumflex: Left Internal Thoracic Artery versus Saphenous Vein

Uchino

Murakami

Mukohara

et al. 2022

Thorac Cardiovasc Surg

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Background This study aimed to compare the short- and long-term outcomes of saphenous vein grafts (SVGs) and in situ left internal thoracic artery (LITA) grafts to the left circumflex artery (LCX) territory. Methods This study included 678 patients who underwent LITA-left anterior descending (LAD) + SVG-LCX grafts and 286 patients who underwent right internal thoracic artery (RITA)-LAD + in situ LITA-LCX grafts from January 2002 to December 2020. Short-term and long-term clinical outcomes were compared using inverse probability of treatment weighting adjustment to reduce selection bias. Results In-hospital mortality was significantly higher for the SVG-LCX group (p = 0.008), whereas deep sternal wound infection was significantly higher in the LITA-LCX group (p = 0.013).Survival rates at 5 and 10 years were 83.12 and 71.45% in the SVG-LCX group, whereas 75.24 and 65.54% in the LITA-LCX group (log-rank p = 0.114). Rates of freedom from cardiac events at 5 and 10 years were 92.82 and 85.24% in the SVG-LCX group, whereas 94.89 and 89.46% in the LITA-LCX group (log-rank p = 0.179).Univariate and multivariate logistic regression analysis showed that proximal severe stenosis was significantly protective against graft dysfunction before discharge (odds ratio, 0.43; 95% confidence interval, 0.23–0.81). Conclusion Deep sternal wound infection was significantly higher for LITA to LCX bypass whereas in-hospital mortality was higher for SVG to LCX. In situ LITA to LCX bypass grafting exhibited similar long-term outcomes with SVG to LCX bypass grafting in adjusted patient cohorts. Proximal severe stenosis of LCX was protective against graft dysfunction.

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Bilateral Internal Thoracic Artery In Situ Versus Y-Composite Graftings: Long-term Outcomes

Cited by 9 publications

References 20 publications

Consensus statement—graft treatment in cardiovascular bypass graft surgery

Consensus statement—graft treatment in cardiovascular bypass graft surgery

Systematic review and meta-analysis of <i>in situ</i> versus composite bimammary coronary artery bypass grafting: immediate outcomes and 30-day mortality

Bypass Grafting to Circumflex: Left Internal Thoracic Artery versus Saphenous Vein

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