Umberto Benedetto1, Mario Gaudino2, Antonino Di Franco3, Massimo Caputo1, Lucas B Ohmes3, Juan Grau4, David Glineur4, Leonard N Girardi3, Gianni D Angelini1. 1. Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom. 2. Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, USA. Electronic address: mfg9004@med.cornell.edu. 3. Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, USA. 4. Division of Cardiac Surgery, Ottawa Heart Institute, Ottawa, Canada.
Abstract
BACKGROUND: We sought to investigate the impact of incomplete revascularization (IR) on long-term survival after isolated coronary artery bypass grafting (CABG). The possible interaction between IR and off-pump surgery was also explored. METHODS: A total of 13,701 patients with multivessel disease undergoing CABG were included in the analysis. All patients received left internal thoracic artery (LITA) to the left anterior descending artery (LAD) territory. IR was defined as at least one diseased arterial territory (right coronary artery [RCA] and/or circumflex [CX] artery) incompletely revascularized. RESULTS: Overall, 3107 (22.7%) patients received IR. After propensity score matching, IR did not increase all-cause death in the overall group (HR 1.09; 95%CI 0.96-1.22; P=0.17). However, when both RCA and CX artery were incompletely revascularized, late survival was significantly lower (HR 2.15; 95%CI 1.57-2.93). IR was associated with a higher risk of death after off-pump (HR 1.26; 95%CI 1.05-1.49) regardless the extent of IR. After on-pump, IR significantly affected survival only when both RCA and CX artery only were incompletely revascularized (HR 2.32; 95%CI 1.27-4.22). CONCLUSIONS: The present analysis shows that in patients with LITA-LAD graft the impact of IR on survival is marginal when only one coronary territory is left ungrafted. When both the RCA and CX territory remain unrevascularized the survival rate is significantly reduced. IR after off-pump CABG is associated with significantly lower survival and affects long-term outcome even when only one coronary territory is not revascularized.
BACKGROUND: We sought to investigate the impact of incomplete revascularization (IR) on long-term survival after isolated coronary artery bypass grafting (CABG). The possible interaction between IR and off-pump surgery was also explored. METHODS: A total of 13,701 patients with multivessel disease undergoing CABG were included in the analysis. All patients received left internal thoracic artery (LITA) to the left anterior descending artery (LAD) territory. IR was defined as at least one diseased arterial territory (right coronary artery [RCA] and/or circumflex [CX] artery) incompletely revascularized. RESULTS: Overall, 3107 (22.7%) patients received IR. After propensity score matching, IR did not increase all-cause death in the overall group (HR 1.09; 95%CI 0.96-1.22; P=0.17). However, when both RCA and CX artery were incompletely revascularized, late survival was significantly lower (HR 2.15; 95%CI 1.57-2.93). IR was associated with a higher risk of death after off-pump (HR 1.26; 95%CI 1.05-1.49) regardless the extent of IR. After on-pump, IR significantly affected survival only when both RCA and CX artery only were incompletely revascularized (HR 2.32; 95%CI 1.27-4.22). CONCLUSIONS: The present analysis shows that in patients with LITA-LAD graft the impact of IR on survival is marginal when only one coronary territory is left ungrafted. When both the RCA and CX territory remain unrevascularized the survival rate is significantly reduced. IR after off-pump CABG is associated with significantly lower survival and affects long-term outcome even when only one coronary territory is not revascularized.
Authors: Piroze M Davierwala; Sergey Leontyev; Jens Garbade; Sven Lehmann; David Holzhey; Martin Misfeld; Michael A Borger Journal: Ann Cardiothorac Surg Date: 2018-07
Authors: Mariusz Kowalewski; Marek Jasiński; Jakub Staromłyński; Marian Zembala; Kazimierz Widenka; Mirosław Brykczyński; Jacek Skiba; Michał Zembala; Krzysztof Bartuś; Tomasz Hirnle; Inga Dziembowska; Piotr Knapik; Zdzisław Tobota; Bohdan Maruszewski; Piotr Suwalski Journal: PLoS One Date: 2020-04-22 Impact factor: 3.240
Authors: Radosław Litwinowicz; Piotr Mazur; Piotr Śliwiński; Magdalena Bryndza; Krzysztof Bartuś; Grzegorz Filip; Artur Bartoszcze; Jacek Piątek; Janusz Konstanty-Kalandyk; Mariusz Kowalewski; Krithika Ramaprabhu; Hubert Hymczak; Bogusław Kapelak; Anna Kędziora Journal: J Thorac Dis Date: 2022-01 Impact factor: 3.005
Authors: Mario Gaudino; Gianni D Angelini; Charalambos Antoniades; Faisal Bakaeen; Umberto Benedetto; Antonio M Calafiore; Antonino Di Franco; Michele Di Mauro; Stephen E Fremes; Leonard N Girardi; David Glineur; Juan Grau; Guo-Wei He; Carlo Patrono; John D Puskas; Marc Ruel; Thomas A Schwann; Derrick Y Tam; James Tatoulis; Robert Tranbaugh; Michael Vallely; Marco A Zenati; Michael Mack; David P Taggart Journal: J Am Heart Assoc Date: 2018-08-21 Impact factor: 5.501
Authors: Mariusz Kowalewski; Marek Jasiński; Jakub Staromłyński; Marian Zembala; Kazimierz Widenka; Michał Oskar Zembala; Krzysztof Bartuś; Tomasz Hirnle; Inga Dziembowska; Piotr Knapik; Marek Deja; Waldemar Wierzba; Zdzisław Tobota; Bohdan J Maruszewski; Piotr Suwalski Journal: J Clin Med Date: 2020-05-04 Impact factor: 4.241