Robert F Tranbaugh1, Thomas A Schwann2, Daniel G Swistel3, Kamellia R Dimitrova4, Laila Al-Shaar5, Darryl M Hoffman4, Charles M Geller4, Milo Engoren6, Sandhya K Balaram3, John D Puskas4, Robert H Habib5. 1. Department of Cardiovascular Surgery, Mount Sinai Beth Israel, New York, New York. Electronic address: rft9008@med.cornell.edu. 2. Division of Cardiothoracic Surgery, University of Toledo Medical Center, Toledo, Ohio. 3. Division of Cardiothoracic Surgery, Mount Sinai St. Luke's, New York, New York. 4. Department of Cardiovascular Surgery, Mount Sinai Beth Israel, New York, New York. 5. Outcomes Research Unit and Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon. 6. Division of Anesthesia, Mercy Saint Vincent Medical Center, Toledo, Ohio.
Abstract
BACKGROUND: It is not clear whether radial artery (RA), right internal thoracic artery (RITA), or saphenous vein (SV) is the preferred second bypass graft during coronary artery bypass graft surgery using the left internal thoracic artery (LITA) in patients aged less or greater than 70 years. METHODS: Late survival data were collected for 13,324 consecutive, isolated, primary coronary artery bypass graft surgery patients from three hospitals. Cox regression analysis was performed on all patients grouped by age. RESULTS: Adjusted Cox regression showed overall better RA versus SV survival (hazard ratio [HR] 0.82, p < 0.001) and no difference in RITA versus SV survival (HR 0.95, p = 0.35). However, the survival benefit of RA versus SV was seen only in patients aged less than 70 years (HR 0.77, p < 0.001); and RITA patients aged less than 70 years also had a survival benefit compared with SV (HR 0.86, p = 0.03). There was no difference in survival for RA versus RITA across all ages. CONCLUSIONS: For patients aged less than 70 years, the optimal grafting strategy is using either RA or RITA as the second preferred graft. In patients aged 70 years or more, RA and RITA grafting should be used selectively. Multiple arterial grafting using either RA or RITA should be more widely utilized during coronary artery bypass graft surgery for patients less than 70 years of age.
BACKGROUND: It is not clear whether radial artery (RA), right internal thoracic artery (RITA), or saphenous vein (SV) is the preferred second bypass graft during coronary artery bypass graft surgery using the left internal thoracic artery (LITA) in patients aged less or greater than 70 years. METHODS: Late survival data were collected for 13,324 consecutive, isolated, primary coronary artery bypass graft surgery patients from three hospitals. Cox regression analysis was performed on all patients grouped by age. RESULTS: Adjusted Cox regression showed overall better RA versus SV survival (hazard ratio [HR] 0.82, p < 0.001) and no difference in RITA versus SV survival (HR 0.95, p = 0.35). However, the survival benefit of RA versus SV was seen only in patients aged less than 70 years (HR 0.77, p < 0.001); and RITA patients aged less than 70 years also had a survival benefit compared with SV (HR 0.86, p = 0.03). There was no difference in survival for RA versus RITA across all ages. CONCLUSIONS: For patients aged less than 70 years, the optimal grafting strategy is using either RA or RITA as the second preferred graft. In patients aged 70 years or more, RA and RITA grafting should be used selectively. Multiple arterial grafting using either RA or RITA should be more widely utilized during coronary artery bypass graft surgery for patients less than 70 years of age.
Authors: Aihua Pu; Lillian Ding; Jungwon Shin; Joel Price; Peter Skarsgard; Daniel R Wong; John Bozinovski; Guy Fradet; James G Abel Journal: JAMA Cardiol Date: 2017-11-01 Impact factor: 14.676
Authors: Mario Gaudino; Roberto Lorusso; Mohamed Rahouma; Ahmed Abouarab; Derrick Y Tam; Cristiano Spadaccio; Gaëlle Saint-Hilary; Jeremy Leonard; Mario Iannaccone; Fabrizio D'Ascenzo; Antonino Di Franco; Giovanni Soletti; Mohamed K Kamel; Christopher Lau; Leonard N Girardi; Thomas A Schwann; Umberto Benedetto; David P Taggart; Stephen E Fremes Journal: J Am Heart Assoc Date: 2019-01-22 Impact factor: 5.501
Authors: Eric Anderson; Matthew Glogoza; Aaron Bettenhausen; Rory Guenther; Dylan Dangerfield; Rick Jansen; Roxanne Newman; Donald Warne; Cornelius Dyke Journal: Health Equity Date: 2018-08-01