Bilateral internal thoracic artery versus radial artery multi-arterial bypass grafting: a report from the STS database†
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- Thomas A Schwann
- Department of Surgery, University of Massachusetts-Baystate, Springfield, MA, USA
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- Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, IL, USA
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- Amelia Wallace
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
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- David Shahian
- Department of Surgery, Harvard Medical School, Boston, MA, USA
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- Mario Gaudino
- Department of Surgery, Weill Cornell Medical College, New York, NY, USA
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- Paul Kurlansky
- Department of Surgery, Columbia University, New York, NY, USA
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- Milo C Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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- Robert F Tranbaugh
- Department of Surgery, Weill Cornell Medical College, New York, NY, USA
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- Alexandra N Schwann
- Department of Surgery, University of Toledo, Toledo, OH, USA
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- Jeffrey P Jacobs
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
Description
<jats:title>Abstract</jats:title><jats:p /><jats:sec><jats:title>OBJECTIVES</jats:title><jats:p>Multi-arterial bypass grafting with bilateral internal thoracic (BITA-MABG) or radial (RA-MABG) arteries improves long-term survival, but its increased complexity raises perioperative safety concerns. We compared perioperative outcomes of RA-MABG and BITA-MABG using the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS-ACSD).</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>We analysed the 2004–2015 BITA-MABG and RA-MABG experience in STS-ACSD. Primary end points were operative mortality (OM) and deep sternal wound infections (DSWI). Risk-adjusted odds ratios [AOR (95% confidence interval)] were derived via multivariable logistic regression. Sensitivity analyses were done in patient sub-cohorts and based on institutional BITA-utilization rates (<5%, 5–10%, 10–20%, 20–40% and >40%).</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Eighty-five thousand nine hundred five RA-MABG (82.5% men; 61 years) and 61 336 BITA-MABG (85.1% men; 59 years) patients were analysed; 41.6% of BITA-MABG and 27.3% of RA-MABG cases came from institutions with low MABG utilization rates (<10%). Unadjusted OM was equivalent for both techniques (BITA-MABG versus RA-MABG: 1.3% vs 1.2%, P = 0.79), while DSWI was lower for RA-MABG (1.0% vs 0.6%, P < 0.001). RA-MABG was associated with lower adjusted OM [AOR = 0.80 (0.69–0.96)] and DSWI [AOR = 0.39 (0.32–0.46)]. Sensitivity analyses confirmed robustness of these findings. Equivalent outcomes were observed at high BITA-use institutions where BITA cases comprised >20% of all cases for OM and ≥40% for DSWI.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This analysis of the STS-ACSD showed that RA-MABG is a generally safer form of multi-arterial coronary artery bypass grafting surgery. However, this advantage is mitigated at institutions with substantial BITA experience.</jats:p></jats:sec>
Journal
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- European Journal of Cardio-Thoracic Surgery
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European Journal of Cardio-Thoracic Surgery 56 (5), 926-934, 2019-04-01
Oxford University Press (OUP)
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Details 詳細情報について
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- CRID
- 1361699995476588032
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- ISSN
- 1873734X
- 10107940
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- Data Source
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- Crossref