Salil V Deo1, Salah E Altarabsheh2, Ishan K Shah3, Yang Hyun Cho4, Michael McGraw5, Basar Sarayyepoglu6, Benjamin Medalion6, Alan H Markowitz6, Soon J Park6. 1. Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA. Electronic address: svd14@case.edu. 2. Department of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan. 3. Department of Surgery, University of Minnesota, Minneapolis-St.Paul, MN, USA. 4. Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan School of Medicine, Samsung Hospital, Seoul, South Korea. 5. Health Sciences Library, Case Western Reserve University, Cleveland, OH, USA. 6. Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA.
Abstract
INTRODUCTION: Bilateral internal thoracic artery grafting appears to be the preferred method to achieve durable long-term coronary artery revascularization. However, data reporting the benefit of this technique in the elderly is very conflicting. METHOD: We performed a systematic review of available literature (till November 2014) using multiple databases to identify studies comparing clinical events in patients undergoing coronary artery bypass grafting using either a single or double internal thoracic artery in the elderly. While early mortality was the primary end-point of inclusion, other adverse events compared were sternal wound infection (deep and superficial), stroke and peri-operative myocardial infarction. Individual and pooled odd's ratios were calculated using the Mantel-Haenzel method (random effect model); sensitivity analysis was performed. Results are presented using 95% confidence intervals. RESULT: Nine retrospective studies (4479 BITA, 7733 LITA patients) fulfilled search criteria. Deep sternal wound infection was significantly higher after BITA harvest [OR 1.86 (1.3-2.5); I(2) = 0%; p < 0.01]. Early mortality (BITA 3.6% vs SITA 3.1%; p = 0.86), stroke [OR 0.7(0.4-1.1); p = 0.1], and peri-operative myocardial infarction (BITA 4.3% vs SITA 2.3%; p = 0.1) were comparable in both cohorts. Long-term survival favored the BITA cohort in two propensity matched studies. CONCLUSION: The incidence of deep sternal wound infection may be significantly higher after the harvest of both internal thoracic arteries in the elderly. While other post-operative adverse events are comparable, data regarding the long-term survival advantage in this cohort is conflicting. Hence, the use of both internal thoracic arteries in this age group needs to be invidualized.
INTRODUCTION: Bilateral internal thoracic artery grafting appears to be the preferred method to achieve durable long-term coronary artery revascularization. However, data reporting the benefit of this technique in the elderly is very conflicting. METHOD: We performed a systematic review of available literature (till November 2014) using multiple databases to identify studies comparing clinical events in patients undergoing coronary artery bypass grafting using either a single or double internal thoracic artery in the elderly. While early mortality was the primary end-point of inclusion, other adverse events compared were sternal wound infection (deep and superficial), stroke and peri-operative myocardial infarction. Individual and pooled odd's ratios were calculated using the Mantel-Haenzel method (random effect model); sensitivity analysis was performed. Results are presented using 95% confidence intervals. RESULT: Nine retrospective studies (4479 BITA, 7733 LITA patients) fulfilled search criteria. Deep sternal wound infection was significantly higher after BITA harvest [OR 1.86 (1.3-2.5); I(2) = 0%; p < 0.01]. Early mortality (BITA 3.6% vs SITA 3.1%; p = 0.86), stroke [OR 0.7(0.4-1.1); p = 0.1], and peri-operative myocardial infarction (BITA 4.3% vs SITA 2.3%; p = 0.1) were comparable in both cohorts. Long-term survival favored the BITA cohort in two propensity matched studies. CONCLUSION: The incidence of deep sternal wound infection may be significantly higher after the harvest of both internal thoracic arteries in the elderly. While other post-operative adverse events are comparable, data regarding the long-term survival advantage in this cohort is conflicting. Hence, the use of both internal thoracic arteries in this age group needs to be invidualized.
Authors: Alexander Iribarne; Philip P Goodney; Alyssa M Flores; Joseph DeSimone; Anthony W DiScipio; Andrea Austin; Jock N McCullough Journal: Ann Thorac Surg Date: 2017-11-01 Impact factor: 4.330
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