Complete myocardial revascularization using only bilateral internal thoracic arteries provides a low-risk and durable 10-year clinical outcome

Glineur, David; Papadatos, Spiridon; Grau, Juan B.; Shaw, Richard E.; Kuschner, Cyrus E.; Aphram, Gaby; Mairy, Y; Vanbelighen, Christophe; Etienne, Pierre Yves

doi:10.1093/ejcts/ezw120

Cited by 18 publications

(9 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8,10 At 5 years, observational and randomized studies indicate that patency rates of both left and right internal-thoracic-artery grafts and of radial-artery grafts exceed 90%. 13,[34][35][36][37] Vein-graft pa- T h e ne w e ngl a nd jou r na l o f m e dicine tency may also be improving over time, which may be related in part to better control of risk factors after CABG. 33 In the ART, the rates of use of aspirin, statins, beta-blockers, and ACE inhibitors (or angiotensin-receptor blockers) at 5 years were high.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9][10] The excellent long-term outcomes of single internal-thoracic-artery grafts 11,12 have stimulated the use of a bilateral internal-thoracic-artery approach that uses both the left and right internal thoracic arteries. [13][14][15][16] Pooled analyses of observational studies suggest that, at 10 years, there are approximately 20% fewer deaths from any cause with bilateral internal-thoracic-artery grafting than with single internal-thoracic-artery grafting. [17][18][19][20][21] However, bilateral internal-thoracic-artery grafting has not been widely adopted because of three main factors: it is a more complex procedure, it is associated with a higher risk of sternal wound complications, and there is a lack of randomized evidence of benefit.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2016

View full text Add to dashboard Cite

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.)

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Due to the lack of arterial grafts, right internal thoracic artery (RITA) has been applied to CABG patients since around 2000. Reportedly, RITA also has good effect on patients with multiple coronary artery diseases [18–20], but RITA is not commonly used in our heart center due to traditional and technical reasons. We will gradually apply RITA to CABG patients in suitable occasions.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Saphenous Vein Y-Grafts in Patients Undergoing Off-Pump Complete Myocardial Revascularization

Zhang

Wang

et al. 2019

Med Sci Monit

View full text Add to dashboard Cite

BackgroundTo evaluate perioperative and mid-term outcomes of saphenous vein Y-grafts in patients with multi-vessel coronary artery disease.Material/MethodsSixty patients who underwent off-pump coronary surgery with Y-graft between 2005 and 2016 were enrolled, including 38 patients with natural Y-graft. Sixty patients with multi-vessel lesions in the same period were randomly selected as a control group.ResultsA total of 484 conduits were employed. The intraoperative variables were insignificantly different between groups, but Y-graft group compared with control group had more grafts (4.2±0.84 vs. 3.87±0.85) and anastomoses (6.30±1.39 vs. 5.62±1.15). No patient died during coronary artery bypass grafting and no episode of perioperative myocardial infarction was found. Follow-up duration lasted from 1 to 137 (40.0±27.7) months. No significant difference between Y-graft group and control group was found in Kaplan-Meier 3-year survival rate (93.4% vs. 88.0%) or 5-year survival rate (81.4% vs. 88.0%).ConclusionsSaphenous vein Y-graft is a feasible and safe revascularization strategy for multi-vessel coronary artery disease patients and brings about satisfactory outcomes.

show abstract

“…Depending on the patient's anatomy, the RITA may even reach the distal RCA territory. As described in previous publications (27,28), in this configuration the free RITA is anastomosed to the posterior wall of the LITA using 8-0 polypropylene suture. To revascularize lesions in the OM or posterior lateral artery (PL), the RITA is anastomosed to the LITA at a 60-degree angle, known as a Y composite ( Figure 3A).…”

Section: Bita Composite Techniquesmentioning

confidence: 99%

Bilateral internal thoracic artery grafting: in situ or composite?

Kawajiri¹,

Grau²,

Fortier³

et al. 2018

Ann. Cardiothorac. Surg.

Self Cite

View full text Add to dashboard Cite

Bilateral internal thoracic artery (BITA) grafting is considered a superior choice for coronary artery bypass grafting (CABG). While the 10-year outcomes of BITA grafting from the recent Arterial Revascularization Trial (ART) are still pending, numerous observational studies have demonstrated the advantages of BITA grafting. These include better long-term graft patency and freedom from arteriosclerosis, in addition to higher survival rate compared to CABG using only the left internal thoracic artery (ITA). The different BITA configurations are in situ and composite-the choice of optimal grafting configuration is challenging. Patient factors such as coronary anatomy, presence of a diseased ascending aorta and the potential need for a future redo sternotomy will influence the choice of the grafting strategy. In situ BITA grafting is associated with excellent clinical outcomes and has been extensively described in the literature. However, uncertainties remain regarding the ideal in situ configuration and design. Composite BITA grafting is the other option that maximizes right ITA (RITA) utilization. In this configuration, the RITA is able to reach the distal circumflex and right coronary artery branches. This approach decreases the need for a third graft conduit.

show abstract

Complete myocardial revascularization using only bilateral internal thoracic arteries provides a low-risk and durable 10-year clinical outcome

Abstract: Performance of an exclusive composite BITA off-pump revascularization strategy optimal and sustained long-term protection from MACCE.

Cited by 18 publications

References 21 publications

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

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

Effectiveness of Saphenous Vein Y-Grafts in Patients Undergoing Off-Pump Complete Myocardial Revascularization

Bilateral internal thoracic artery grafting: in situ or composite?

Contact Info

Product

Resources

About