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Single versus bilateral internal thoracic artery grafting in patients with low ejection fraction.
| Content Provider | Europe PMC |
|---|---|
| Author | Farkash, Ariel Pevni, Dmitri Mohr, Rephael Kramer, Amir Ziv-Baran, Tomer Paz, Yosef Nesher, Nahum Ben-Gal, Yanai |
| Editor | Chen., Robert |
| Copyright Year | 2020 |
| Abstract | AbstractCoronary artery bypass grafting (CABG) is the standard of care for the treatment of complex coronary artery disease. However, the optimal surgical treatment for patients with reduced left ventricular function with low ejection fraction (EF) is inconclusive. In our center, left-sided coronary grafting with bilateral internal thoracic artery (BITA) is generally the preferred method for surgical revascularization, also for patients with low EF. We compared early and long-term outcomes between BITA grafting and single internal thoracic artery (SITA) grafting in patients with low EF.We evaluated short- and long-term outcomes of all patients who underwent surgical revascularization in our center during 1996 to 2011, according to EF ≥30% and <30%. Univariate and multivariate analyses were performed. In addition, patients who underwent BITA and SITA grafting were matched using propensity score matching.In total, 5337 patients with multivessel disease underwent surgical revascularization during the study period. Of them, 394 had low EF. Among these, 188 underwent SITA revascularization and 206 BITA grafting. Those who underwent SITA were more likely to have comorbidities such as chronic obstructive pulmonary disease, diabetes, congestive heart failure, chronic renal failure, and a critical preoperative condition including preoperative intra-aortic balloon pump insertion.Statistically significant differences were not observed between the SITA and BITA groups in 30-day mortality (8.5% vs 6.8%, P = .55), sternal wound infection (2.7% vs 1.0%, P = .27), stroke (3.7% vs 6.3%, P = .24), and perioperative myocardial infarction (5.9% vs 2.9%, P = .15). Long-term survival (median follow up of 14 years, interquartile range, 11.2–18.9) was also similar between the groups. Propensity score matching (129 matched pairs) yielded similar early and long-term outcomes for the groups.This study did not demonstrate any clinical benefit for BITA compared with SITA revascularization in individuals with low EF. |
| ISSN | 00257974 |
| Journal | Medicine |
| Volume Number | 99 |
| PubMed Central reference number | PMC7598827 |
| Issue Number | 44 |
| PubMed reference number | 33126324 |
| e-ISSN | 15365964 |
| DOI | 10.1097/md.0000000000022842 |
| Language | English |
| Publisher | Lippincott Williams & Wilkins |
| Publisher Date | 2020-10-01 |
| Publisher Place | Hagerstown, MD |
| Access Restriction | Open |
| Rights License | This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. |
| Subject Keyword | bilateral mammary artery bilateral internal thoracic artery coronary artery bypass grafting coronary artery bypass surgery ejection fraction low ejection fraction single mammary artery single internal thoracic artery |
| Content Type | Text |
| Resource Type | Article |
| Subject | Medicine |
