TY - JOUR
T1 - In situ skeletonized bilateral thoracic artery for left coronary circulation
T2 - a 20-year experience
AU - Bonacchi, Massimo
AU - Prifti, Edvin
AU - Bugetti, Marco
AU - Cabrucci, Francesco
AU - Cresci, Michael
AU - Luca, Fabiana
AU - Parise, Orlando
AU - Matteucci, Francesco
AU - Sani, Guido
AU - Johnson, Daniel M.
AU - Gelsomino, Sandro
PY - 2020/1
Y1 - 2020/1
N2 - OBJECTIVES: Our goal was to analyse the outcomes in a patient population using a standardized technique for coronary artery bypass grafting (CABG) consisting of total arterial myocardial revascularization utilizing the in situ skeletonized bilateral thoracic artery for left coronary circulation. We also explored potential predictors of long-time unfavourable outcomes.METHODS: Patients undergoing total arterial myocardial revascularization using in situ skeletonized bilateral thoracic artery for left coronary circulation between January 1997 and May 2017 were included prospectively in this study. The median follow-up (100% complete) was 103 months (interquartile range 61-189 months) and ranged from 1 to 245 months.RESULTS: A total of 1325 consecutive patients were recruited. During the follow-up period, there were 131 deaths (9.8%), 146 repeat revascularizations (11.0%) and 229 major adverse cardiac events (17.2%). The 18-year freedom from major adverse cardiac events was 62.69.3%, 62.5 +/- 6.3% and 53.9 +/- 11.0%, respectively. Multivariable models showed that a left ventricular ejection fraction = 80 years (P=0.002) were independent predictors of diminished long-term survival. Moreover, peripheral vascular disease and off-pump coronary artery bypass (both, P <0.001) predicted repeat revascularization. Finally, age >= 80 years, peripheral vascular disease, left ventricular ejection fractionCONCLUSIONS: Coronary artery bypass using the in situ skeletonized bilateral thoracic artery for left coronary circulation configuration for total arterial myocardial revascularization resulted in satisfactory long-term results with a low incidence of death and late events and may represent a technique of choice in selected patients having CABG. Larger and long-term prospective studies are, however, warranted.
AB - OBJECTIVES: Our goal was to analyse the outcomes in a patient population using a standardized technique for coronary artery bypass grafting (CABG) consisting of total arterial myocardial revascularization utilizing the in situ skeletonized bilateral thoracic artery for left coronary circulation. We also explored potential predictors of long-time unfavourable outcomes.METHODS: Patients undergoing total arterial myocardial revascularization using in situ skeletonized bilateral thoracic artery for left coronary circulation between January 1997 and May 2017 were included prospectively in this study. The median follow-up (100% complete) was 103 months (interquartile range 61-189 months) and ranged from 1 to 245 months.RESULTS: A total of 1325 consecutive patients were recruited. During the follow-up period, there were 131 deaths (9.8%), 146 repeat revascularizations (11.0%) and 229 major adverse cardiac events (17.2%). The 18-year freedom from major adverse cardiac events was 62.69.3%, 62.5 +/- 6.3% and 53.9 +/- 11.0%, respectively. Multivariable models showed that a left ventricular ejection fraction = 80 years (P=0.002) were independent predictors of diminished long-term survival. Moreover, peripheral vascular disease and off-pump coronary artery bypass (both, P <0.001) predicted repeat revascularization. Finally, age >= 80 years, peripheral vascular disease, left ventricular ejection fractionCONCLUSIONS: Coronary artery bypass using the in situ skeletonized bilateral thoracic artery for left coronary circulation configuration for total arterial myocardial revascularization resulted in satisfactory long-term results with a low incidence of death and late events and may represent a technique of choice in selected patients having CABG. Larger and long-term prospective studies are, however, warranted.
KW - Internal thoracic artery
KW - Arterial myocardial revascularization
KW - Coronary artery bypass
KW - LONG-TERM
KW - FOLLOW-UP
KW - MYOCARDIAL REVASCULARIZATION
KW - GRAFT
KW - LOCATION
KW - SINGLE
KW - SURVIVAL
KW - OUTCOMES
KW - DISEASE
KW - FLOW
U2 - 10.1093/ejcts/ezz138
DO - 10.1093/ejcts/ezz138
M3 - Article
C2 - 31056683
SN - 1010-7940
VL - 57
SP - 160
EP - 167
JO - European Journal of Cardio-Thoracic Surgery
JF - European Journal of Cardio-Thoracic Surgery
IS - 1
ER -