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

DI GIAMMARCO, GABRIELE
2000-01-01
2000
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
WOS:000165203700019
120
990
996
6
11044326
BACKGROUND: We evaluated whether bilateral internal thoracic arteries provide the same long-term results when used as in situ grafts and as Y grafts. Methods and Results: From October 1991 to February 2000, 1818 patients had bilateral internal thoracic arteries used as in situ (n = 1378, group A) or as Y grafts (n = 440, group B). The number of anastomoses per patient and the number of bilateral internal thoracic artery anastomoses per patient were higher in group B (3.1 +/- 0.9 and 2.7 +/- 0.9) than in group A (2.9 +/- 0.8 and 2.2 +/- 0.6) (both P <.001). The number of right internal thoracic artery anastomoses per patient rose from 1.0 +/- 0. 3 in group A to 1.4 +/- 0.6 in group B (P <.001), and the number of sequential anastomoses per right internal thoracic artery graft rose from 4.1\% to 34.3\% (P <.001). Thirty-day mortality was 2.0\% in group A versus 2.5\% in group B (P = not significant). No difference in postoperative course was detected. Eight-year survivals were 95.8\% +/- 2.7\% in group A versus 94.8\% +/- 4.0\% in group B (P = not significant), and event-free survivals were 95.2\% +/- 2.9\% in group A versus 93.6\% +/- 4.4\% in group B (P = not significant). Early angiograms were obtained in 295 patients (945 anastomoses, 863 distal and 82 proximal Y grafts), 213 patients (611) in group A and 82 patients (334) in group B. Patency rate was 98.8\% in group A and 96.0\% in group B (P = not significant), whereas grade A patency rate was 97.2\% in group A and 96.4\% in group B (P = not significant). Late angiograms were obtained in 88 patients (25 in group A and 63 in group B) at a mean of 17.5 +/- 18.4 months: patency rate was 100\% in group A and 99.2 in group B (P = not significant), and grade A patency rate was 98.6\% in group A and 98.8\% in group B (P = not significant). No Y anastomosis was occluded or stenosed. COMMENT: Survival, incidence of cardiac events, and angiographic patency in the early and late phases are similar for bilateral internal thoracic arteries used either in situ or as Y grafts. However, Y grafting with bilateral internal thoracic arteries increases the number of anastomoses per bilateral thoracic artery, as well as the flexibility of the right internal thoracic artery.
Aged; Anastomosis; Surgical; Chi-Square Distribution; Coronary Angiography; Coronary Artery Bypass; Female; Humans; Male; Middle Aged; Myocardial Revascularization; Survival Analysis; Thoracic Arteries; Treatment Outcome; Vascular Patency
http://dx.doi.org/10.1067/mtc.2000.110249
2-s2.0-0033744564
7
info:eu-repo/semantics/article
262
A. M., Calafiore; M., Contini; G., Vitolla; M. D., Mauro; V., Mazzei; G., Teodori; DI GIAMMARCO, Gabriele
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11564/177087
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