Factors affecting patency of internal thoracic artery graft: clinical and angiographic study in 1434 symptomatic patients operated between 1982 and 20021

Shah, Pallav; Durairaj, M; Gordon, Ian; Fuller, John A.; Rosalion, Alexander; Seevanayagam, Siven; Tatoulis, James; Buxton, Brian F.

doi:10.1016/j.ejcts.2004.02.037

Cited by 102 publications

(55 citation statements)

References 22 publications

(11 reference statements)

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“…Risk difference analyzes showed 40 SSI prevented per 1000 coronary bypass surgeries with an off-pump approach. Other studies showed the used mammary artery during coronary bypass surgery have superior patency rates of >90% up to 15 years of follow-up [23]. Therefore it is preferred to use the mammary artery if needed both; however, the disadvantage is the reduction of blood supply of the sternum.…”

Section: Incidence Of Ssi Discussionmentioning

confidence: 99%

The Impact of a Microbial Sealant to Reduce Surgical Site Infections in High Risk Cardiac Surgery Patients

Pm¹,

Gabbieri²,

Weymann³

et al. 2014

J Med Microb Diagn

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Section: Incidence Of Ssi Discussionmentioning

confidence: 99%

The Impact of a Microbial Sealant to Reduce Surgical Site Infections in High Risk Cardiac Surgery Patients

Pm¹,

Gabbieri²,

Weymann³

et al. 2014

J Med Microb Diagn

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“…In our unselected patients, the TF-1 rate was 13.2% and freedom from TF-1 is correspondingly 86.8%. Interestingly, the five years patency rate have been reported to be 72% of Saphenous vein grafts and 88% -92% for internal mammary artery grafts [14] [15]. In plain words, PCI with a drug eluting stent appears to have almost the same durability as mammary grafts after five years observation.…”

Section: The Durability Of Pci With Drug Eluting Stentsmentioning

confidence: 94%

A Modified Treatment Failure Classification System with Complete and Exhaustive Accounting of Any Adverse Events Related to the Previous Percutaneous Coronary Intervention

Galløe¹,

Jeppesen²,

Boesgaard³

et al. 2014

WJCD

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Objectives: To determine the clinical outcome related to treatment failure of the percutaneous coronary intervention (PCI) itself. Background: When considering the addition of PCI to the medical treatment of angina, it is necessary to know the balance between the benefit and the risk of the PCI itself, but the latter remains unknown. The usual outcome measures are imprecise because they contain events unrelated to the previous PCI and because some events clearly caused by PCI treatment failures are omitted. Methods: In total, 2098 unselected patients were randomized to receive either sirolimus-(n = 1065) or paclitaxel-(n = 1033) eluting coronary stents and followed for five years in the SORT OUT II. Any death, cardiac death, myocardial infarction (MI), stent thrombosis and documented stenosis was classified and combined to a "patient oriented clinical outcome" (POCO), the classical "major adverse cardiac events" (MACE) and the new "PCI-treatment * Corresponding author. A. M. Galløe et al. 406oriented clinical outcome" (TOCO). Results: POCO occurred in 746 patients (35.6%), MACE in 467 patients (22.3%) and TOCO in 293 patients (14.0%), thus TOCO amounted to 39% of the POCO and to 63% of the MACE. Conclusion: By introduction of the present PCI treatment failure classification system, the clinical outcome of PCI-treatment itself may be credulously estimated by the rate of TOCO and eventually PCI is substantially better than what might be perceived from the classically used POCO and MACE rates.

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“…Graft failure is therefore an expected finding in this population, and the overall patency rate will be correspondingly lower in this selected population. 5 In response to Drs Shah, Baker, and Knight, the lower patency rates compared with the studies by Shah et al 6,7 may reflect differences in definitions, because we defined a severe stenosis as being Ն70% (versus Ն80% in their studies), and may reflect differences in patient populations. We did not provide patency information of Y versus sequential grafts versus free grafts because the number of grafts in some of the subgroups was rather small.…”

Section: Responsementioning

confidence: 95%

Letters Regarding Article by Khot et al, “Radial Artery Bypass Grafts Have an Increased Occurrence of Angiographically Severe Stenosis and Occlusion Compared With Left Internal Mammary Arteries and Saphenous Vein Grafts”

Acar

Cook

2005

Circulation

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Since its first clinical use by Carpentier in 1971, 1 the radial artery (RA) has become one of the grafts of choice in coronary surgery. The article by Khot et al 2 claims that the patency of RA grafts is lower than that of internal mammary artery (IMA) as well as venous grafts. We believe that their methodology is flawed, primarily because the sample studied is composed almost exclusively of patients presenting with angina, ECG changes, or both. In most other published reports, only Ϸ20% of patients have recurrent angina at 5 years. Therefore, we believe that the denominator used to calculate the rates of patency is incorrect, and the results obtained by the authors may be misleading. Furthermore, it would appear that the RA was often used in high-occlusion-risk situations, which could account for the low observed patency rate in this highly selected population. For example, 22% of the patients underwent redo surgery, a substantially high proportion of patients in a daily practice, and a situation in which target vessels are often suboptimal. In one third of the cases, the RA was anastomosed to the right coronary artery, which is known to be at high risk for occlusion, whereas the number of right IMA grafts constructed in this area was so small that it did not allow a statistical comparison. Therefore, we believe that it is dangerous to extrapolate the patency data observed in this series to a homogeneous cohort of patients. These results are at variance with previously published series, which established that the patency of the RA graft was 92% and 83% at 1 and 5 years, respectively. These rates are comparable to those of the right IMA graft. Several studies have reported that use of the RA as opposed to vein grafts improved survival and decreased the incidence of cardiac-related events within the first postoperative years. 3,4 In our practice, this graft has been used on a routine basis since 1989. The low morbidity rate associated with RA harvesting led us to use this conduit rather than the right IMA to complement the left IMA-to-left anterior descending artery graft. 5 In conclusion, we believe that the message transmitted by the title of this article relies on a flawed methodology and that its conclusions are contradicted by recently published data. Christophe Acar, MD To the Editor:The recent article by Khot et al 1 raises serious concerns about patency when the radial artery is used as a graft in coronary artery bypass grafting (CABG). The results of their retrospective analysis suggest that in patients predominantly presenting with signs and symptoms of myocardial ischemia after CABG, radial artery grafts have lower patency rates than do left internal mammary artery and saphenous vein grafts (SVGs). These sensational results are not only contrary to those of other researchers 2,3 but also contradict the expected benefits of radial artery use.Saphenous veins used as aortocoronary conduits are apt to develop intimal hyperplasia, followed by atheromatous change. This characteristic has been proved hist...

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Factors affecting patency of internal thoracic artery graft: clinical and angiographic study in 1434 symptomatic patients operated between 1982 and 20021

Abstract: Even in a patient cohort that had adverse symptoms, excellent LITA and RITA patency was achieved which almost remained constant through all time intervals studied.

Cited by 102 publications

References 22 publications

The Impact of a Microbial Sealant to Reduce Surgical Site Infections in High Risk Cardiac Surgery Patients

The Impact of a Microbial Sealant to Reduce Surgical Site Infections in High Risk Cardiac Surgery Patients

A Modified Treatment Failure Classification System with Complete and Exhaustive Accounting of Any Adverse Events Related to the Previous Percutaneous Coronary Intervention

Letters Regarding Article by Khot et al, “Radial Artery Bypass Grafts Have an Increased Occurrence of Angiographically Severe Stenosis and Occlusion Compared With Left Internal Mammary Arteries and Saphenous Vein Grafts”

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