共查询到20条相似文献，搜索用时 15 毫秒
1.
2.
3.
4.
Suguru Ohira Hiroaki Miyata Sachiko Yamazaki Satoshi Numata Noboru Motomura Shinichi Takamoto Hitoshi Yaku 《The Journal of thoracic and cardiovascular surgery》2019,157(1):166-173.e1
Objectives
Despite its survival benefits, bilateral internal thoracic artery (BITA) grafting is not commonly utilized due to concerns over deep sternal wound infection (DSWI). The present study investigated the early outcome of BITA grafting and analyzed the risk of DSWI using a Japanese national database (the Japan Adult Cardiovascular Surgery Database).Methods
Data from 560 hospitals were used. Between April 2012 and December 2015, BITA was harvested in 14,249 patients, corresponding to 32.6% of isolated coronary artery bypass cases. DSWI was defined as a wound infection requiring surgical intervention and/or the administration of antibiotics. Multiple logistic regression analysis was employed to model the risk of DSWI.Results
The mean age was 67.1 years. The prevalence of diabetes, renal failure, hemodialysis, and liver dysfunction was 51.8%, 21.2%, 7.8%, and 1.2%, respectively. The incidence of DSWI and operative mortality was 1.6 (234 patients) and 1.6% (226 patients), respectively. The operative mortality rate in patients with DSWI was 13.7% (32 patients). The off-pump technique was used in 72.8%, with a conversion rate of 2.5%. Female sex, diabetes mellitus, chronic lung disease, renal failure, liver dysfunction, ejection fraction ≤60%, shock status, reoperation, preoperative intra-aortic balloon pump use, and an increased operative time were independent risk factors for DSWI after BITA grafting. The off-pump technique did not reduce the risk of DSWI.Conclusions
The present study showed that early outcomes of BITA grafting were satisfactory regarding DSWI and operative mortality. The current data are informative to predict the risk of DSWI when performing BITA grafting. 相似文献5.
Takashi Hirotani Tsukasa Nakamichi Mamoru Munakata Shigeyuki Takeuchi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2003,51(10):488-495
Objective: Internal thoracic artery (ITA) grafts provide better early and long-term patency than saphenous vein (SV) grafts. Furthermore,
bilateral ITA grafting has recently demonstrated better long-term results than unilateral ITA grafting. However, its use in
the elderly is controversial. Methods: From March 1991 through November 2001, 307 consecutive patients aged 65 years or over undergoing isolated coronary artery
bypass grafting (CABG) were reviewed, and the influence of bilateral ITA grafting on the early and long-term results was evaluated.
All ITA grafts were harvested as a pedicle, and almost all of which were used as in-situ grafts. Results: Operative mortality in 138 patients undergoing bilateral ITA grafting was 1.4%, and in 108 patients undergoing unilateral
ITA grafting, the rate was 0.9%. Predischarge angiography conducted in 97% of the subjects showed that the patency rate of
all the ITA grafts (98.9%) was superior (p<0.0001) to that of all the SV grafts (93.6%). In comparisons of survival and freedom
from cardiac events at 10 years after CABG, the bilateral use of ITA grafts was proved to be more beneficial than the unilateral
use (p<0.05). Conclusions: It was demonstrated that bilateral ITA grafting could be performed with acceptable mortality and morbidity. Moreover, it
offers better long-term survival and freedom from cardiac events than either unilateral ITA grafting or no ITA grafting. Bilateral
ITA grafting thus can serve as a favorable procedure even in elderly patients. 相似文献
6.
Umberto Benedetto Douglas G. Altman Marcus Flather Stephen Gerry Alastair Gray Belinda Lees David P. Taggart 《The Journal of thoracic and cardiovascular surgery》2018,155(6):2346-2355.e6
Background
The Arterial Revascularization Trial has been designed to answer the question whether the use of bilateral internal thoracic arteries can improve 10-year outcomes when compared with single internal thoracic arteries. In the Arterial Revascularization Trial, a significant proportion of patients initially allocated to bilateral internal thoracic arteries received other conduit strategies. We sought to investigate the incidence and clinical implication of bilateral internal thoracic artery graft conversion in the Arterial Revascularization Trial.Methods
Among patients enrolled in the Arterial Revascularization Trial (n = 3102), we excluded those allocated to single internal thoracic arteries (n = 1554), those who did not undergo surgery (n = 16), and those who underwent operation but withdrew after randomization (n = 7). Propensity score matching was used to compare converted versus nonconverted bilateral internal thoracic artery groups.Results
A total of 1525 patients were operated with the intention to receive bilateral internal thoracic artery grafting. Of those, 233 (15.3%) were converted to other conduit selection strategies. Incidence of conversion largely varied across 131 participating surgeons (from 0% to 100%). The most common reason for bilateral internal thoracic artery graft conversion was the evidence of at least 1 internal thoracic artery that was not suitable, which was reported in 77 cases. Patients with intraoperative bilateral internal thoracic artery graft conversion received a lower number of grafts (2.95 ± 0.84 vs 3.21 ± 0.74; P < .001). However, the hospital mortality rate was comparable to that of those who did not require bilateral internal thoracic artery graft conversion (0% vs 1.6%; P = .1), as well as the incidence of major complications. At 5 years, we found a nonsignificant excess of deaths (11.9% vs 8.4%; P = .1) and major adverse events (17.1% 13.2%; P = .1) mainly driven by an excess of revascularization in patients requiring conversion.Conclusions
The incidence of intraoperative bilateral internal thoracic artery graft conversion is not infrequent. Bilateral internal thoracic artery graft conversion is not associated with increased operative morbidity, but its effect on late outcomes remains uncertain. 相似文献7.
8.
Nishant Saran Chaim Locker Sameh M. Said Richard C. Daly Simon Maltais John M. Stulak Kevin L. Greason Alberto Pochettino Hartzell V. Schaff Joseph A. Dearani Lyle D. Joyce Brian D. Lahr David L. Joyce 《The Journal of thoracic and cardiovascular surgery》2018,155(6):2331-2343
Background
We sought to identify the trends in bilateral internal thoracic artery use and determine the degree to which the survival advantage of bilateral internal thoracic artery revascularization persists among perceived “high-risk” patients, compared with the use of left internal thoracic artery alone.Methods
A retrospective review was conducted of patients who underwent isolated coronary artery bypass grafting for multivessel coronary artery disease at the Mayo Clinic between January 2000 and December 2015. Propensity score matching was performed between patients with bilateral internal thoracic artery and left internal thoracic artery alone grafts (1011 matched pairs). Effect of bilateral internal thoracic artery use on survival in “high-risk” patients (ejection fraction <40%, body mass index ≥30, age ≥70 years, diabetes, chronic lung disease, cerebrovascular accident) was evaluated.Results
A total of 6468 isolated coronary artery bypass grafts were performed (5431 using left internal thoracic artery alone, 1037 using bilateral internal thoracic artery). There was an increasing trend in bilateral internal thoracic artery use (P value for linear trend = .005), with the percentage of coronary artery bypass grafting cases with bilateral internal thoracic artery doubling over the last 4 years (13% in 2012 to 27% in 2015). Propensity-matched comparisons showed a survival advantage for bilateral internal thoracic artery (hazard ratio, 0.81; 95% confidence interval, 0.66-0.99; P = .043). Risk of deep sternal wound infection, although higher in the bilateral internal thoracic artery group, was not significant (1.2% vs 0.5%; P = .088). None of the “high-risk” subsets of patients showed an adverse effect of bilateral internal thoracic artery on survival.Conclusions
Bilateral internal thoracic artery use in coronary artery bypass grafting is increasing over time. There is a consistent survival benefit with bilateral internal thoracic artery use, extending to patients with higher-risk comorbidities, suggesting the need for further expansion in use of this technique. 相似文献9.
Kazuhiko Iwahashi Atsushi Omura Toshihiro Kawahira Masayoshi Okada 《General thoracic and cardiovascular surgery》2008,56(12):599-601
A 46-year-old man with anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland syndrome)
is reported. We successfully performed coronary artery bypass grafting with the use of bilateral internal thoracic arteries
and ligation of the anomalous left coronary artery. The patient was discharged from the hospital after an uneventful postoperative
course and postoperative coronary angiography, which revealed patent internal thoracic arteries and no leakage of blood flow
from the anomalous left coronary artery to the pulmonary artery. This surgical procedure is technically simple and useful
for adult patients with Bland-White-Garland syndrome. To our knowledge, this is one of only a few reports on coronary artery
bypass grafting with bilateral internal thoracic arteries as a treatment of Bland-White-Garland syndrome. 相似文献
10.
11.
12.
13.
14.
15.
Giovanni Filardo Baron L. Hamman Briget da Graca Danielle M. Sass Natalie J. Machala Safiyah Ismail Benjamin D. Pollock Ashley W. Collinsworth Paul A. Grayburn 《The Journal of thoracic and cardiovascular surgery》2018,155(1):172-179.e5
Background
Despite many studies comparing on- versus off-pump coronary artery bypass graft (CABG), there is no consensus as to whether one of these techniques offers patients better outcomes.Methods
We searched PubMed from inception to June 30, 2015, and identified additional studies from bibliographies of meta-analyses and reviews. We identified 42 randomized controlled trials (RCTs) and 31 rigorously adjusted observational studies (controlling for the Society of Thoracic Surgeons-recognized risk factors for mortality) reporting mortality for off-pump versus on-pump CABG at specified time points. Trial data were extracted independently by 2 researchers using a standardized form. Differences in probability of mortality (DPM) were estimated for the RCTs and observational studies separately and combined, for time points ranging from 30 days to 10 years.Results
RCT-only data showed no significant differences at any time point, whereas observational-only data and the combined analysis showed short-term mortality favored off-pump CABG (n = 1.2 million patients; 36 RCTs, 26 observational studies; DPM [95% confidence interval (CI)], ?44.8% [?45.4%, ?43.8%]) but that at 5 years it was associated with significantly greater mortality (n = 60,405 patients; 3 RCTs, 5 observational studies; DPM [95% CI], 10.0% [5.0%, 15.0%]). At 10 years, only observational data were available, and off-pump CABG showed significantly greater mortality (DPM [95% CI], 14.0% [11.0%, 17.0%]).Conclusions
Evidence from RCTs showed no differences between the techniques, whereas rigorously adjusted observational studies (with >1.1 million patients) and the combined analysis indicated that off-pump CABG offers lower short-term mortality but poorer long-term survival. These results suggest that, in real-world settings, greater operative safety with off-pump CABG comes at the expense of lasting survival gains. 相似文献16.
17.
18.
Giuseppe Tavilla Eline F. Bruggemans Hein Putter 《The Journal of thoracic and cardiovascular surgery》2019,157(6):2228-2236
ObjectiveThe added value of total arterial revascularization in coronary artery bypass grafting becomes particularly apparent when evaluating long-term results. We previously reported on our 10-year outcomes of total arterial revascularization using bilateral internal thoracic and gastroepiploic arteries as in situ grafts in patients with 3-vessel disease. This study aimed to increase the follow-up period to 20 years.MethodsWe updated clinical outcomes of 201 patients operated on between 1992 and 2002. At that time, the technique was primarily performed in patients with a longer life expectancy. Primary end points were overall survival and freedom from the composite of major adverse cardiac events. Secondary end points were the separate cardiac events.ResultsExtended follow-up included all patients. The median follow-up time was 19.2 years (interquartile range, 16.2-20.0). The respective 15- and 20-year Kaplan-Meier estimated survival probabilities were 73.9% (95% confidence interval [CI], 67.2%-79.5%) and 63.5% (95% CI, 55.7%-70.4%) for overall survival and 57.9% (95% CI, 50.7%-64.5%) and 47.9% (95% CI, 40.1%-55.3%) for freedom from major adverse cardiac events. The respective estimated cumulative incidences at 15 and 20 years were 7.0% (95% CI, 3.5%-10.6%) and 7.8% (95% CI, 4.0%-11.6%) for myocardial infarction, 8.6% (95% CI, 4.7%-12.5%) and 9.3% (95% CI, 5.2%-13.3%) for percutaneous reintervention, 7.0% (95% CI, 3.5%-10.5%) and 7.0% (95% CI, 3.5%-10.5%) for reoperation, 8.6% (95% CI, 4.7%-12.6%) and 12.9% (95% CI, 7.6%-18.2%) for cardiac death, and 10.8% (95% CI, 6.5%-15.2%) and 15.2% (95% CI, 9.8%-20.6%) for death from other causes.ConclusionsThe use of in situ bilateral internal thoracic and gastroepiploic arteries provides outstanding 15- and 20-year survival and cardiac event-free survival probabilities. Further studies are needed in older patients with more severe comorbidities. Nevertheless, the results from this and scarce other studies on 15- to 20-year outcomes of total arterial revascularization suggest that cardiac surgeons should embrace the application of total arterial grafting to further reduce the risks of long-term cardiac events, especially during the second decade after surgery. 相似文献
19.