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Formica F, Hernandez-Vaquero D, Tuttolomondo D, Gallingani A, Singh G, Pattuzzi C, Niccoli G, Lorusso R, Nicolini F. Results beyond 5-years of surgery or percutaneous approach in severe coronary disease. Reconstructed time-to-event meta-analysis of randomized trials. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:383-392. [PMID: 37816454 DOI: 10.1016/j.rec.2023.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/20/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES There is controversy about the optimal revascularization strategy in severe coronary artery disease (CAD), including left main disease and/or multivessel disease. Several meta-analyses have analyzed the results at 5-year follow-up but there are no results after the fifth year. We conducted a systematic review and meta-analysis of randomized clinical trials, comparing results after the fifth year, between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) using drug-eluting stents in patients with severe CAD. METHODS We analyzed all clinical trials between January 2010 and January 2023. The primary endpoint was all-cause mortality. The databases of the original articles were reconstructed from Kaplan-Meier curves, simulating an individual-level meta-analysis. Comparisons were made at certain cutoff points (5 and 10 years). The 10-year restricted median survival time difference between CABG and PCI was calculated. The random effects model and the DerSimonian-Laird method were applied. RESULTS The meta-analysis included 5180 patients. During the 10-year follow-up, PCI showed a higher overall incidence of all-cause mortality (HR, 1.19; 95%CI, 1.04-1.32; P=.008)]. PCI showed an increased risk of all-cause mortality within 5 years (HR, 1.2; 95%CI, 1.06-1.53; P=.008), while no differences in the 5-10-year period were revealed (HR, 1.03; 95%CI, 0.84-1.26; P=.76). Life expectancy of CABG patients was slightly higher than that of PCI patients (2.4 months more). CONCLUSIONS In patients with severe CAD, including left main disease and/or multivessel disease, there was higher a incidence of all-cause mortality after PCI compared with CABG at 10 years of follow-up. Specifically, PCI has higher mortality during the first 5 years and comparable risk beyond 5 years.
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Affiliation(s)
- Francesco Formica
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | | | | | - Alan Gallingani
- Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Gurmeet Singh
- Department of Critical Care Medicine and Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Claudia Pattuzzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Cardiology Unit, University Hospital of Parma, Parma, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Department, Maastricht University Medical Centre, Heart and Vascular Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Francesco Nicolini
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
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Du H, Gu X, Zhang Z, Dong Z, Ran X, Zhou L. Effect of right internal mammary artery versus radial artery as a second graft vessel in coronary artery bypass grafting on postoperative wound infection in patients: A meta-analysis. Int Wound J 2024; 21:e14592. [PMID: 38424286 PMCID: PMC10904365 DOI: 10.1111/iwj.14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 03/02/2024] Open
Abstract
Few studies have shown that radial artery (RA), which is used as a secondary arterial graft, offers superior results compared with right internal thoracic artery (RIMA) in coronary artery bypass grafting (CABG). In a meta-analysis of observational studies starting in 2023, we looked at the effect of re-operation on postoperative infection and haemorrhage in CABG with RA vs. RIMA. The electronic database up to October 2023 was examined in the course of the research. Analysis was carried out on the clinical trials of postoperative wound infections and haemorrhage re-surgery. Among 912 trials associated with CABG, we selected 8 trials to be included in the final data analysis. The main results were secondary wound infection and re-operation after surgery. The odds ratios (OR) and confidence intervals (CIs) were computed on the basis of a randomized or fixed-effect model of wound infection and re-operation. Seven trials showed a significant reduction in the risk of wound infection in RA treated as a secondary artery transplant compared with RIMA (OR, 1.60; 95% CI, 1.03, 2.47 p = 0.04); Four trials showed that RIMA was not significantly different from RA in the rate of re-operation for postoperative bleeding (OR, 1.31; 95% CI, 0.60, 2.88 p = 0.50). In CABG, RA is used as a secondary arterial conduit graft to lower the risk of wound infection in CABG patients.
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Affiliation(s)
- Hong Du
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Xiaowei Gu
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Zhiyuan Zhang
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Zichao Dong
- Department of Cardio SurgeryWuHan Asia Cardiac Disease HospitalWuhanChina
| | - Xiaofei Ran
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
| | - Li Zhou
- Department of Cardio Thoracic SurgeryNo.988 Hospital of Joint Logistics Support ForceJiaozuoChina
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Formica F, Gallingani A, Tuttolomondo D, Hernandez-Vaquero D, D'Alessandro S, Singh G, Grassa G, Pattuzzi C, Nicolini F. Very Long-term Outcome of Bilateral Internal Thoracic Artery in Diabetic Patients: A Systematic Review and Reconstructed Time-To-Event Meta-analysis. Curr Probl Cardiol 2024; 49:102135. [PMID: 37863459 DOI: 10.1016/j.cpcardiol.2023.102135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
The benefits of single (SITA) and bilateral internal thoracic arteries (BITA) in diabetics undergoing coronary bypass grafting (CABG) are conflicting. We undertook a study-level meta-analysis to compare early and long-term outcomes of both CABG configurations. PubMed, CENTRAL, and EMBASE were searched for studies comparing BITA versus SITA for isolated CABG surgery in diabetics. Randomized trials or observational studies were considered eligible for the analysis. Kaplan-Meier curves of long-term survival were reconstructed and compared with Cox linear regression; incidence rate ratios (IRR) with 95% confidence intervals (CI) for long-term survival were calculated. Landmark analysis and time-varying hazard ratio (HR) were analyzed. Odds ratios (OR) were extracted for early mortality, postoperative stroke, deep sternal wound infection (DSWI), and myocardial infarction (MI). A random effects meta-analysis was performed. Sensitivity analyses included leave-one-out-analyses and meta-regression. Thirteen studies (7332 patients) were included. Overall, at 20-year follow-up, BITA was associated with higher survival (HR = 0.77; 95% CI, 0.71-0.84; P < 0.0001). Time-varying HR and landmark analysis reported BITA was associated with a higher rate of 10-year survival (HR = 0.75, 95% CI 0.68-0.82, P < 0.0001), while from 10 to 20-year follow-up no difference was revealed (HR = 0.99, 95% CI 0.82-1.19, P = 0.93). There was no increase in early mortality, postoperative MI, stroke, or DSWI between the groups. At meta-regression, the higher the age, the higher the long-term overall survival in patients with BITA. In diabetics, the BITA approach is associated with improved 10-year survival with no increase in early mortality, MI, stroke, or DSWI. In the 10-20-year timeframe, BITA and SITA showed comparable survival.
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Affiliation(s)
- Francesco Formica
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Alan Gallingani
- Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | | | | | | | - Gurmeet Singh
- Department of Critical Care Medicine and Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Giulia Grassa
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Claudia Pattuzzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Francesco Nicolini
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
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Goulden CJ. Percutaneous coronary intervention versus coronary artery by-pass grafting in premature coronary artery disease: What is the evidence? -A narrative review. Perfusion 2023:2676591231223356. [PMID: 38108274 DOI: 10.1177/02676591231223356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Coronary artery disease (CAD) remains one of the leading causes of death globally. In the United States of America, in 2016, 19% of all patients under the age of 65 died of cardiovascular disease despite improvements in primary prevention. The premature clinical onset of symptoms in the young population (<60 years) is much more aggressive than in the older population, and the overall long-term prognosis is poor. CAD appears to have a rapidly progressive form in those under the age of 60 due to genetic predisposition, smoking, and substance abuse, however, the ideal management strategy is still yet to be established. The two primary methods of establishing coronary revascularization are percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Despite the increasing prevalence of CAD in the young population, they are consistently underrepresented in major randomized clinical trials of each revascularization strategy. Both CABG and PCI are known to have similar survival rates, but PCI is associated with higher repeat revascularization rate. Many argue this may be due to the progressive nature of CAD combined with the vessel patency time required in a patient under 60 with potentially another 20-30 years of life. There is little in literature regarding the outcomes of these various revascularization strategies in populations under 60 years with CAD. This review summarises the current evidence for each revascularisation strategy in patients under the age of 60 and suggests future avenues of research for this unique age group.
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Formica F, D'Alessandro S. Radial artery versus right mammary artery: the fight is always open, and statistics rule. Gen Thorac Cardiovasc Surg 2023; 71:261-262. [PMID: 36849868 DOI: 10.1007/s11748-023-01916-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Francesco Formica
- Department of Medicine and Surgery, Cardiac Surgery Clinic, University of Parma, Via Gramsci, 14, 43126, Parma, Parma, Italy.
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Formica F, Gallingani A, Tuttolomondo D, Hernandez-Vaquero D, Singh G, Pattuzzi C, Maestri F, Niccoli G, Ceccato E, Lorusso R, Nicolini F. Long-term outcomes comparison between surgical and percutaneous coronary revascularization in patients with multivessel coronary disease or left main disease. A systematic review and study level meta-analysis of randomized trials. Curr Probl Cardiol 2023; 48:101699. [PMID: 36921648 DOI: 10.1016/j.cpcardiol.2023.101699] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
Recent randomized trials comparing coronary artery bypass graft (CABG) with percutaneous coronary intervention (PCI) utilizing drug-eluting stents in patients with left main (LMD) disease and/or multivessel disease (MVD), reported conflicting results. We performed a study level meta-analysis comparing the two interventions for the treatment of LMD or MVD. Using electronic databases, we retrieved 6 trials, between January, 2010 and December, 2022. Five-years Kaplan-Meier curves of endpoints where reconstructed. Comparisons were made by Cox-linear regression frailty model and by landmark analysis. A random-effect method was applied. 8269 patients were included and randomly assigned to CABG (n=4135) or PCI (n=4134). During 5-years follow-up, PCI showed a higher incidence of all-cause mortality [hazard ratio (HR) 1.28; 95% confidence interval (CI), 1.11-1.47; p<0.0001)], spontaneous myocardial infarction (MI) (HR 1.84; 95% CI, 1.54-2.19; p<0.0001) and repeat coronary revascularization (HR 1.96; 95% CI, 1.72-2.24; p<0.0001). There was no long-term difference between the two interventions for cardiovascular death (p=0.14) and stroke (p=0.20), although the incidence of stroke was higher with CABG within 30-days from intervention (p<0.0001). PCI was associated with an increased risk for composite endpoints (p<0.0001) and major cerebral and cardiovascular events. (p<0.0001). In conclusion, at 5-year follow-up, in patients with LMD and/or MVD there was a significant higher incidence of all-cause mortality, spontaneous MI and repeat revascularization with PCI compared to CABG. The incidence of stroke was higher with CABG during the post-procedural period, but no difference was found during 5-years follow-up. Longer follow-up is mandatory to better define outcome difference between the two interventions.
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Affiliation(s)
- Francesco Formica
- University of Parma, Department of Medicine and Surgery, Parma, Italy.
| | - Alan Gallingani
- Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | | | | | - Gurmeet Singh
- Department of Critical Care Medicine and Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Claudia Pattuzzi
- University of Parma, Department of Medicine and Surgery, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | | | - Giampaolo Niccoli
- University of Parma, Department of Medicine and Surgery, Parma, Italy; Cardiology Unit, University Hospital of Parma, Parma, Italy
| | | | - Roberto Lorusso
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Francesco Nicolini
- University of Parma, Department of Medicine and Surgery, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
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Formica F, Maestri F, Nicolini F. Multiple and total arterial grafts are not a mirage anymore! JTCVS OPEN 2023; 13:197-198. [PMID: 37063162 PMCID: PMC10091138 DOI: 10.1016/j.xjon.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- Francesco Formica
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | | | - Francesco Nicolini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
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Royse A, Ren J, Royse C, Tian DH, Fremes S, Gaudino M, Benedetto U, Woo YJ, Goldstone AB, Davierwala P, Borger M, Vallely M, Reid CM, Rocha R, Glineur D, Grau J, Shaw R, Paterson H, El-Ansary D, Boggett S, Srivastav N, Pawanis Z, Canty D, Bellomo R. Coronary Artery Bypass Surgery Without Saphenous Vein Grafting. J Am Coll Cardiol 2022; 80:1833-1843. [DOI: 10.1016/j.jacc.2022.08.795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 11/05/2022]
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Kemp U, Davies RA. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 34:735-738. [PMID: 35149863 PMCID: PMC9070453 DOI: 10.1093/icvts/ivac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/18/2021] [Accepted: 01/02/2022] [Indexed: 11/18/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘What is the best choice for third conduit when using bilateral internal mammary arteries for coronary artery bypass grafting—radial artery or saphenous vein graft?’. Altogether >525 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Overall, there was no survival benefit demonstrated with the use of a radial artery over the use of a saphenous vein graft as a choice of third conduit following bilateral internal mammary artery grafts for coronary artery bypass grafting. The main limitation of the current evidence available is the restricted follow-up periods and the high attrition rates with small sample sizes affecting the strength of conclusions that can be drawn beyond 10 years of follow-up. We conclude that despite previous evidence supporting improved long-term patency of radial arterial grafts, there is no strong evidence that the use of a radial artery, over a saphenous vein graft, has any survival benefit when used as the third conduit following bilateral internal mammary artery grafts.
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Affiliation(s)
- Ursula Kemp
- Cardiothoracic Department, St George Hospital, Sydney, Australia
- Corresponding author. Cardiothoracic Department, St George Hospital, Gray St, Kogarah, NSW 2217, Australia. Tel: +61-408905831; e-mail: (U. Kemp)
| | - Reece A Davies
- Cardiothoracic Department, St George Hospital, Sydney, Australia
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Composite Total Arterial Revascularization Techniques Comparing Second Internal Mammary Artery And Radial Artery. Ann Thorac Surg 2021; 114:1088-1089. [PMID: 34582761 DOI: 10.1016/j.athoracsur.2021.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022]
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Formica F, D'Alessandro S. Most important is the arterial conduits use. Ann Thorac Surg 2021; 114:1087-1088. [PMID: 34492214 DOI: 10.1016/j.athoracsur.2021.07.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 07/29/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Francesco Formica
- Cardiac Surgery Unit, Department of Medicine and Surgery, University of Parma, UOC Cardiochirurgia, Azienda Ospedaliera-Universitaria di Parma Via A. Gramsci, 14 43126 Parma, Italy.
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Formica F, Maestri F, Nicolini F, D'Alessandro S. Total Arterial Revascularization: It Is Time for a Dedicated Team. J Am Coll Surg 2021; 233:580. [PMID: 34456132 DOI: 10.1016/j.jamcollsurg.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022]
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Formica F, Maestri F, D'Alessandro S, Di Mauro M, Singh G, Gallingani A, Nicolini F. Survival effect of radial artery usage in addition to bilateral internal thoracic arterial grafting: A meta-analysis. J Thorac Cardiovasc Surg 2021; 165:2076-2085.e9. [PMID: 34462132 DOI: 10.1016/j.jtcvs.2021.06.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/08/2021] [Accepted: 06/30/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Little evidence shows whether the radial artery (RA) as third arterial graft provides superior outcomes compared with the use of the bilateral internal thoracic artery (BITA) and saphenous vein (SV) graft in patients undergoing coronary artery bypass grafting. A meta-analysis of propensity score-matched observational studies that compared the long-term outcomes of coronary artery bypass grafting with the use of BITA and the RA (BITA + RA) versus BITA and SV (BITA + SV) was performed. METHODS Electronic databases from January 2000 to November 2020 were screened. Studies that reported long-term mortality were analyzed. The primary outcome was long-term overall mortality. A secondary end point was in-hospital/30-day mortality. Pooled hazard ratio with 95% confidence interval (CI) were calculated for survival and time-to-event analysis according to a random effect model. Differences were expressed as odds ratio with 95% CI for in-hospital/30-day mortality. RESULTS Six propensity score-matched studies that reported on 2500 matched patients (BITA + RA: 1250; BITA + SV: 1250) were identified for comparison. The use of BITA + RA was not statistically associated with early mortality (odds ratio, 0.90; 95% CI, 0.36-2.28; P = .83). The mean follow-up time ranged from 7.5 to 12 years. The pooled analysis of long-term survival revealed a significant difference between the 2 groups favoring BITA + RA treatment (hazard ratio, 0.71; 95% CI, 0.50-0.91; P = .031). The survival rate for BITA + RA versus BITA + SV at 5, 10, and 15 years were: 96.2% versus 94.8%, 88.9% versus 87.4%, and 83% versus 77.9%, respectively (log rank test, P = .02). CONCLUSIONS In patients with coronary artery bypass grafting, BITA + RA usage is not associated with higher rates of operative risk and is associated with superior long-term overall survival.
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D'Alessandro S, Maestri F, Nicolini F, Formica F. Total Arterial Revascularization - A Fascinating Approach Still Not Widely Accepted. Braz J Cardiovasc Surg 2021; 36:441-442. [PMID: 34387982 PMCID: PMC8357384 DOI: 10.21470/1678-9741-2021-0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Francesco Maestri
- Cardiac Surgery Unit, Parma General Hospital, Department of Medicine and Surgery, University of Parma, Italy
| | - Francesco Nicolini
- Cardiac Surgery Unit, Parma General Hospital, Department of Medicine and Surgery, University of Parma, Italy
| | - Francesco Formica
- Cardiac Surgery Unit, Parma General Hospital, Department of Medicine and Surgery, University of Parma, Italy
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Jegaden OJL, Farhat F, Jegaden MPO, Hassan AO, Eker A, Lapeze J. Does the Addition of a Gastroepiploic Artery to Bilateral Internal Thoracic Artery Improve Survival? Semin Thorac Cardiovasc Surg 2021; 34:92-98. [PMID: 33600960 DOI: 10.1053/j.semtcvs.2021.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
Abstract
It is unclear whether the additional conduit to supplement bilateral internal thoracic arteries (BITA) influences the patient outcome in coronary surgery. This retrospective study compared long-term survival of patients undergoing left-sided BITA grafting in which the third conduit to the right coronary system (RCA) was either vein graft (SVG) or gastroepiploic artery (GEA). From 1989 to 2014, 1432 consecutive patients underwent left-sided revascularization with BITA associated with SVG (n = 599) or GEA (n = 833) to RCA. Propensity score was calculated by logistic regression model and patients were matched 1 to 1 leading to 2 groups of 320 matched patients. The primary end point was the overall mortality from any cause. GEA was used in significantly lower risk patients. The 30-day mortality was 1.6% without influence of the graft configuration. Postoperative follow-up was 13.6 ± 6.6 years and was 94% complete. The significant difference in patients' survival observed at 20 years in favor of GEA in unmatched groups (48 ± 4% vs 33 ± 6%, P < 0.001) was not confirmed in matched groups (41 ± 7% vs 36 ± 7%, P = 0.112). In multivariable Cox model analysis, the conduit used to RCA did not influence the long-term survival in matched groups, like no other graft configuration or operative parameter. Only complete revascularization remained predictor of survival (P = 0.016), with age (P < 0.0001), diabetes status (P = 0.007), and left ventricle ejection fraction (P < 0.0001). Long-term survival in patients undergoing BITA grafting is not affected by using GEA as third arterial conduit in alternative to SVG. Further studies are necessary to assess its impact on long-term cardiac events.
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Affiliation(s)
- Olivier J L Jegaden
- Department of cardiac surgery, Mediclinic Middle East Abu Dhabi, UAE; Department of surgery MBRU University, Dubai, UAE; Department of surgery UCLB University Lyon, France.
| | - Fadi Farhat
- Department of surgery UCLB University Lyon, France; Department of cardiac surgery, HCL, Lyon, France
| | | | - Amar O Hassan
- Department of biomedical data sciences, MBRU University, Dubai, UAE
| | | | - Joel Lapeze
- Department of cardiac surgery, Infirmerie Protestante, Lyon, France
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Rayol SC, Van den Eynde J, Cavalcanti LRP, Escorel AC, Rad AA, Amabile A, Botelho W, Ruhparwar A, Zhigalov K, Weymann A, Sobral DC, Sá MPBO. Total Arterial Coronary Bypass Graft Surgery is Associated with Better Long-Term Survival in Patients with Multivessel Coronary Artery Disease: a Systematic Review with Meta-Analysis. Braz J Cardiovasc Surg 2021; 36:78-85. [PMID: 33594864 PMCID: PMC7918394 DOI: 10.21470/1678-9741-2020-0653] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The benefit of total arterial revascularization (TAR) in coronary artery bypass grafting (CABG) remains a controversial issue. This study sought to evaluate whether there is any difference on the long-term results of TAR and non-TAR CABG patients. METHODS The Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Clinical Trials.gov, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Google Scholar databases were searched for studies published by October 2020. Randomized clinical trials and observational studies with propensity score matching comparing TAR versus non-TAR CABG were included. Random-effects meta-analysis was performed. The current barriers to implementation of TAR in clinical practice and measures that can be used to optimize outcomes were reviewed. RESULTS Fourteen publications (from 2012 to 2020) involving a total of 22,746 patients (TAR: 8,941 patients; non-TAR: 13,805 patients) were included. The pooled hazard ratio (HR) for long-term mortality (over 10 years) was lower in the TAR group than in the non-TAR group (random effect model: HR 0.676, 95% confidence interval 0.586-0.779, P<0.001). There was evidence of low heterogeneity of treatment effect among the studies for mortality, and none of the studies had a particular impact on the summary result. The result was not influenced by age, sex, or comorbidities. We identified low risk of publication bias related to this outcome. CONCLUSION This review found that TAR presents the best long-term results in patients who undergo CABG. Given that many patients are likely to benefit from TAR, its use should be encouraged.
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Affiliation(s)
- Sérgio C Rayol
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE, Recife, Pernambuco, Brazil
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE, Recife, Pernambuco, Brazil
| | - Antonio Carlos Escorel
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE, Recife, Pernambuco, Brazil
| | | | - Andrea Amabile
- Department of Cardiac Surgery, University of Chicago Medicine, Chicago, United States of America
| | - Wilson Botelho
- Instituto do Coração - InCor, Universidade de São Paulo - USP, São Paulo, São Paulo, Brazil
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | | | - Michel Pompeu B O Sá
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Pernambuco, Brazil.,University of Pernambuco - UPE, Recife, Pernambuco, Brazil
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17
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Isomura T, Hirota M, Yoshida M, Yamagishi S, Sumi K, Yoshida S. The Growth Potential and Patency of Free Right Internal Thoracic Arteries Verified by Computed Tomography Angiography. Ann Thorac Surg 2021; 112:1990-1996. [PMID: 33484672 DOI: 10.1016/j.athoracsur.2021.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of the left internal thoracic artery (LITA) is the gold standard in coronary artery bypass graft surgery (CABG). Multiarterial grafting for CABG is being increasingly emphasized. This study aimed to resolve the utility of the right internal thoracic artery (RITA) for multiple CABG as "free" RITA and described new evidence. METHODS One hundred sixty-three patients received solo CABG with bilateral internal thoracic arteries between 2005 and 2018. The RITA was used as in situ RITA, group A (n = 62), and the composite graft created with saphenous vein graft (SVG), group B (n = 101). The patency rate and graft size of the composite free RITA and SVG were examined by coronary computed tomography angiography. RESULTS The average number of distal anastomoses per patient was 3.4 ± 1.0 in group A, and 4.2 ± 1.1 in group B (P < .001). The sequential grafting with free RITA was in 86 patients. The patency rate of both LITA and RITA was similar in both groups. In group B, 40 patients received late computed tomography angiography at a mean of 46 months (range, 17 to 175). The late patency rate was 95.1% in LITA and 96.9% in free RITA. The diameter of free RITA increased from 2.06 ± 0.34 mm to 2.37 ± 0.23 mm (P = .036); that of in situ LITA increased from 2.08 ± 0.51 mm to 2.44 ± 0.49 mm (P = .047); and that of composite SVG decreased from 4.1 ± 0.9 mm to 2.6 ± 0.7 mm (P < .001). CONCLUSIONS Multiple bypass grafting can be sufficiently achieved with LITA and free RITA. The growth potential of free RITA and in situ LITA might play the important role of expected long-term patency.
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Affiliation(s)
- Tadashi Isomura
- Department of Cardiovascular Surgery, IMS Tokyo Katsushika General Hospital, Tokyo, Japan.
| | - Masanori Hirota
- Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Minoru Yoshida
- Department of Cardiovascular Surgery, IMS Tokyo Katsushika General Hospital, Tokyo, Japan
| | - Shunsuke Yamagishi
- Department of Cardiovascular Surgery, IMS Tokyo Katsushika General Hospital, Tokyo, Japan
| | - Kohei Sumi
- Department of Cardiovascular Surgery, IMS Tokyo Katsushika General Hospital, Tokyo, Japan
| | - Shigehiko Yoshida
- Department of Cardiovascular Surgery, IMS Tokyo Katsushika General Hospital, Tokyo, Japan
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18
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Urso S, Sadaba R, González JM, Nogales E, Pettinari M, Tena MÁ, Paredes F, Portela F. Total arterial revascularization strategies: A meta-analysis of propensity score-matched observational studies. J Card Surg 2019; 34:837-845. [PMID: 31376215 DOI: 10.1111/jocs.14169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/11/2019] [Accepted: 06/16/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY We explored the current evidence available on total arterial revascularization (TAR) carrying out a meta-analysis of propensity score-matched studies comparing TAR versus non-TAR strategy. METHODS PubMed, EMBASE, and Google Scholar were searched for propensity score-matched studies comparing TAR vs non-TAR. The generic inverse variance method was used to compute the combined hazard ratio (HR) of long-term mortality. The Der-Simonian and Laird method were used to compute the combined risk ratio (RR) of 30-day mortality, deep sternal wound infection, and reoperation for bleeding. RESULTS Eighteen TAR vs non-TAR matched populations were included. Meta-analysis showed a significant benefit in terms of long-term survival of the TAR group over the non-TAR group (HR: 0.73; 95% confidence interval [CI]: 0.68-0.78). Better long-term survival over non-TAR strategy was confirmed by both subgroups: TAR with the bilateral internal mammary artery (BIMA) and TAR without BIMA. Meta-regression suggests that TAR may offer a higher protective survival effect in diabetic patients (coefficient: -0.0063; 95% CI: -0.01 to 0.0006), when carried out with BIMA (coefficient: -0.15; 95% CI: -0.27 to -0.03) or using three arterial conduits (coefficient: -0.12; 95% CI: -0.25 to 0.007). A TAR strategy carried out using BIMA, differently from TAR without BIMA, increases the risk of deep sternal infection (RR: 1.44; 95% CI: 1.17-1.77). CONCLUSIONS TAR provides a long-term survival benefit compared with the non-TAR strategy. Also, compared with TAR without BIMA, TAR with BIMA may offer a higher protective long-term survival effect at the expense of a higher risk of sternal deep wound infection.
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Affiliation(s)
- Stefano Urso
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Rafael Sadaba
- Cardiac Surgery Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jesús María González
- Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Eliú Nogales
- Cardiology Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - Matteo Pettinari
- Cardiac Surgery Department, Ziekenhuis Oost Limburg, Genk, Belgium
| | - María Ángeles Tena
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Federico Paredes
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Francisco Portela
- Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
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19
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Commentary: Arteries and veins: Choices abound. J Thorac Cardiovasc Surg 2019; 158:154. [PMID: 30853234 DOI: 10.1016/j.jtcvs.2019.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 11/23/2022]
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20
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Tam DY, Fremes SE. Commentary: Radial artery and bilateral mammary arteries in coronary artery bypass grafting: How much is too much? J Thorac Cardiovasc Surg 2019; 158:152-153. [PMID: 30739780 DOI: 10.1016/j.jtcvs.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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