David Glineur1. 1. Department of Cardiovascular Surgery, Cliniques St Luc, Bouge and the Department of Cardiovascular Medicine and Surgery, Cliniques Universitaire St Luc, Brussels, Belgium.
Abstract
BACKGROUND: The long-term benefit of multiple arterial grafts for coronary artery bypass (CABG) is not clear. This protocol was elaborated to see if multiple arterial grafts would provide better long-term outcomes when compared with conventional strategies. METHODS: Prospective data was collected for 588 patients undergoing isolated CABG between 1985 and 1995. We analyzed long term survival and freedom from cardiac death. The analysis compared patients with BITA grafting receiving a right gastro-epiploic artery (RGEA) versus those receiving a saphenous vein graft (SVG) as a third conduit. Cox proportional hazards modelling was used to adjust for relevant confounders. RESULTS: The mean age was 59±9 years and 49% received BITA. Mean follow-up was 16.1±5.4 years. Multivariable analysis revealed in that patients receiving the RGEA as a third conduit had superior overall survival (HR, 0.46; P=0.015) and cardiac survival (HR, 0.20; P=0.005) compared to those receiving an SVG. CONCLUSIONS: In our experience, the use of multiple arterial grafting is independently associated with superior outcomes. Furthermore, the use of a third arterial conduit targeted to the RCA should be considered to improve long-term survival.
BACKGROUND: The long-term benefit of multiple arterial grafts for coronary artery bypass (CABG) is not clear. This protocol was elaborated to see if multiple arterial grafts would provide better long-term outcomes when compared with conventional strategies. METHODS: Prospective data was collected for 588 patients undergoing isolated CABG between 1985 and 1995. We analyzed long term survival and freedom from cardiac death. The analysis compared patients with BITA grafting receiving a right gastro-epiploic artery (RGEA) versus those receiving a saphenous vein graft (SVG) as a third conduit. Cox proportional hazards modelling was used to adjust for relevant confounders. RESULTS: The mean age was 59±9 years and 49% received BITA. Mean follow-up was 16.1±5.4 years. Multivariable analysis revealed in that patients receiving the RGEA as a third conduit had superior overall survival (HR, 0.46; P=0.015) and cardiac survival (HR, 0.20; P=0.005) compared to those receiving an SVG. CONCLUSIONS: In our experience, the use of multiple arterial grafting is independently associated with superior outcomes. Furthermore, the use of a third arterial conduit targeted to the RCA should be considered to improve long-term survival.
Entities:
Keywords:
Bilateral thoracic arteries; bilateral mammary grafting; gastro-epiploic artery (RGEA); long term follow-up; multiple arterial grafting; third arterial grafting
Authors: David Glineur; William D'hoore; Laurent de Kerchove; Philippe Noirhomme; Joel Price; Claude Hanet; Gebrine El Khoury Journal: J Thorac Cardiovasc Surg Date: 2011-11 Impact factor: 5.209
Authors: David Glineur; Claude Hanet; William D'hoore; Alain Poncelet; Laurent De Kerchove; Pierre Yves Etienne; Philippe Noirhomme; Gebrine El Khoury Journal: Eur J Cardiothorac Surg Date: 2009-04-15 Impact factor: 4.191
Authors: Michele Di Mauro; Marco Contini; Angela L Iacò; Antonio Bivona; Massimo Gagliardi; Egidio Varone; Paolo Bosco; Antonio M Calafiore Journal: J Thorac Cardiovasc Surg Date: 2009-02-07 Impact factor: 5.209
Authors: David Glineur; William D'hoore; Gebrine El Khoury; Sixte Sondji; Gregory Kalscheuer; Jean-Christophe Funken; Jean Rubay; Alain Poncelet; Parla Astarci; Robert Verhelst; Philippe Noirhomme; Claude Hanet Journal: J Am Coll Cardiol Date: 2008-01-15 Impact factor: 24.094