Patency of Internal Thoracic Artery Compared to Vein Grafts - Postoperative Angiographic Findings in 1189 Symptomatic Patients in 12 Years

Gansera, Brigitte; Schmidtler, F.; Angelis, I; Kiask, T; Kemkes, B. M.; Botzenhardt, Florian

doi:10.1055/s-2007-965372

Cited by 44 publications

(37 citation statements)

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“…33 Bilateral internal-thoracic-artery grafting may provide better long-term outcomes than single internal-thoracic-artery grafting plus vein grafts because of the superior long-term patency of arterial grafts, as compared with vein grafts. 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.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 The single internal-thoracic-artery graft has a 10-year rate of angiographic patency exceeding 90%, as compared with 50% for vein grafts. [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.…”

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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%

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

et al. 2016

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“…Due to superior long-term patency rates when directly compared with other conduit options, the left internal mammary artery (LIMA) should be considered the first choice among options for CABG inflow conduit and should be used whenever feasible [16,17]. However, given the common context of the critically ill, multiply injured trauma patient, the use of LIMA is often made difficult.…”

Section: Discussionmentioning

confidence: 99%

Management of Traumatic Coronary Artery Injuries: Advantages of Off-Pump Coronary Artery Bypass

et al. 2009

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Coronary artery injuries are rare but highly lethal. Debate exists as to the best treatment for this complex set of injuries, with historical treatment favoring arterial ligation. Although conventional coronary artery bypass grafting using cardiopulmonary bypass has been used somewhat successfully, enthusiasm for off-pump CABG (OPCAB) has grown more recently. We report two unique cases of left anterior descending coronary arterial injuries managed successfully with OPCAB.

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“…1 Surgically harvested autologous grafts, such as the left internal mammary and radial arteries or the greater saphenous vein, from patients are considered the gold standard for CABG procedures. [2][3][4][5] Other autologous arterial/venous grafts, cryopreserved cadaveric grafts, umbilical vein grafts, and arterial allografts have also been tried but with limited success because of associated complications. [6][7][8][9][10][11] Although autologous vessels from patients remain the grafts of choice, in many cases, previous harvest, morbidity at the donor site, or disease progression limit the availability of native grafts.…”

Section: Vascular Tissue Engineering: Unmet Clinical Needmentioning

confidence: 99%