The Experts below are selected from a list of 10965 Experts worldwide ranked by ideXlab platform
Bruce W. Lytle - One of the best experts on this subject based on the ideXlab platform.
-
Role of Internal Thoracic Artery Grafts in Reoperative Coronary Artery Bypass Surgery
Arterial Grafting for Coronary Artery Bypass Surgery, 2020Co-Authors: Joseph F. Sabik, Bruce W. LytleAbstract:Coronary reoperations can be performed safely with Internal Thoracic Artery grafts. There does not appear to be any increased perioperative risk in patients undergoing reoperation who have had prior Internal Thoracic Artery grafting, or in patients having single or bilateral Internal Thoracic Artery grafting at reoperation. Some observational studies demonstrate a decreased hospital risk in patients undergoing reoperative coronary surgery who have had prior Internal Thoracic Artery grafting. This may be due to the excellent long termpatency of Internal Thoracic Artery grafts and how this preserves ventricular function. There is also some evidence that Internal Thoracic Artery grafting at reoperation improves long term survival as compared to a reoperative strategy of only saphenous vein grafting.
-
decision making for patients with patent left Internal Thoracic Artery grafts to left anterior descending
The Annals of Thoracic Surgery, 2009Co-Authors: Sreekumar Subramanian, Eugene H. Blackstone, Joseph F. Sabik, Penny L Houghtaling, Edward R Nowicki, Bruce W. LytleAbstract:Background It is unknown whether coronary reintervention confers a survival advantage when a previously placed left Internal Thoracic Artery graft to the left anterior descending coronary Artery (LAD) is patent. We compared survival after medical therapy, percutaneous intervention, and reoperative coronary Artery bypass grafting in such patients who developed non-LAD territory jeopardy. Methods From 1971 to 2000, 4,640 patients with prior coronary Artery bypass grafting that included left Internal Thoracic Artery to LAD grafting were found on angiography during active follow-up to have a patent left Internal Thoracic Artery to LAD graft, but at least 50% stenosis of non-LAD territories or grafts to them. Two survival analyses were performed: (1) intent-to-treat, which included patients undergoing reoperative coronary Artery bypass grafting (n = 731) or percutaneous intervention (n = 994) within 6 weeks of angiography or medical management (n = 2,782), and (2) competing risk/crossover, in which patients were classified as medically managed until crossover to coronary Artery bypass grafting or percutaneous intervention. Results In the intent-to-treat analysis, propensity-adjusted early ( p ≤ 0.05). In the competing risk/crossover analysis, adjusted survival was best for medically treated patients early; however, late survival was similar among all three groups. Conclusions Patients with patent left Internal Thoracic Artery to LAD grafts who develop non-LAD territory jeopardy derive no survival benefit from reintervention, consistent with previous observations that for coronary reintervention to improve survival, the LAD territory must be jeopardized. Reintervention in patients with a patent left Internal Thoracic Artery to LAD graft may be warranted to relieve symptoms, without expecting a survival benefit.
-
Does use of a right Internal Thoracic Artery increase deep wound infection and risk after previous use of a left Internal Thoracic Artery
The Journal of Thoracic and Cardiovascular Surgery, 2006Co-Authors: Lars G. Svensson, Mubashir A. Mumtaz, Eugene H. Blackstone, Jingyuan Feng, Michael K. Banbury, Joseph F. Sabik, B. Gosta Pettersson, Steven M. Gordon, Bruce W. LytleAbstract:Objective To determine whether adding right Internal Thoracic Artery to previous left Internal Thoracic Artery bypass at reoperation increases deep sternal wound infection and hospital mortality, particularly in diabetic patients. Methods Reoperations (n = 2875; 2381 men) in patients with previous left Internal Thoracic Artery bypass were performed between January 1990 and January 2003; 1939 (67%) had no repeat Internal Thoracic Artery grafting, 923 (32%) received an additional right Internal Thoracic Artery graft, and 13 (0.5%) had bilateral Internal Thoracic Artery grafting with reuse of the left Internal Thoracic Artery. Of the patients, 352 (12%) were insulin-treated and 590 (21%) non–insulin-treated diabetics. Multivariable logistic regression analysis was used to identify preoperative variables associated with right versus non–right Internal Thoracic Artery use in diabetics and nondiabetics and to formulate propensity models. Propensity scores were used for matching and adjusted multivariable analyses of deep wound infection and hospital mortality. Results Deep wound infection occurred in 3.0% (7/230) of diabetics receiving right Internal Thoracic Artery grafts, 2.2% (5/230) of propensity-matched diabetics receiving non–right Internal Thoracic Artery grafts ( P = . 6), in 1.1% (6/538) of nondiabetics receiving right Internal Thoracic Artery grafts, and in 1.0% (5/538) of matched non-diabetic patients receiving non–right Internal Thoracic Artery grafts ( P = . 8). Corresponding hospital mortality in these matched groups was 1.7% (4/230) versus 6.1% (14/230) for diabetics ( P = . 02) and 2.6% (14/538) versus 3.5% (19/538) for nondiabetics ( P = . 4). Risk factors for deep wound infection included higher weight ( P = . 0003), higher New York Heart Association functional class ( P = . 03), and less severe left anterior descending disease ( P = . 03). Risk factors for death were ( P Conclusions Use of the right Internal Thoracic Artery for reoperations does not increase the risk of deep wound infections in diabetics or nondiabetics and does not increase mortality.
-
comparison of saphenous vein and Internal Thoracic Artery graft patency by coronary system
The Annals of Thoracic Surgery, 2005Co-Authors: Joseph F. Sabik, Eugene H. Blackstone, Bruce W. Lytle, Penny L Houghtaling, Delos M CosgroveAbstract:Background We sought to compare saphenous vein and Internal Thoracic Artery graft patency by coronary system. Methods From 1972 to 1999, 50,278 patients underwent primary coronary surgery; subsequently, 4,333 had angiography of 2,121 Internal Thoracic Artery and 8,733 saphenous vein grafts. Longitudinal analysis was used to model graft occlusion and identify risk factors. Using the model, patency was calculated twice for each graft and compared first as if an Internal Thoracic Artery, and second as if a saphenous vein, were used. Results Unadjusted 1-, 5-, and 10-year patency was 93%, 88%, and 90% for Internal Thoracic arteries and 78%, 65%, and 57% for saphenous veins. At 10 years, Internal Thoracic arteries were more likely than saphenous veins to be patent to left anterior descending in 99.1% of cases, to diagonals in 98.3%, to circumflex in 98.3%, to posterior descending Artery in 98.5%, and to right coronary arteries in 82.5%. For right coronary arteries, saphenous vein patency was equivalent to or better than Internal Thoracic Artery patency early after surgery. However, by 10 years, Internal Thoracic Artery patency was better in right coronary arteries with 70% stenosis or greater. At all times after surgery and all levels of clinically important coronary stenosis, Internal Thoracic Artery patency surpassed saphenous vein patency in grafts to the left anterior descending, diagonal, circumflex, and posterior descending arteries. Conclusions Internal Thoracic arteries demonstrate better patency than saphenous veins except when grafting moderately stenosed right coronary arteries. When bypassing right coronary arteries with less than 70% stenosis, saphenous veins may be a better choice.
-
the effect of bilateral Internal Thoracic Artery grafting on survival during 20 postoperative years
The Annals of Thoracic Surgery, 2004Co-Authors: Bruce W. Lytle, Eugene H. Blackstone, Joseph F. Sabik, F. D. Loop, Penny L Houghtaling, Delos M CosgroveAbstract:Background To compare survival of patients receiving bilateral Internal Thoracic Artery grafts and single Internal Thoracic Artery grafts more than 20 postoperative years, assess magnitude of benefit, and identify predictors of benefit. Methods From cohorts of 8123 patients receiving single Internal Thoracic Artery grafts and 2001 receiving bilateral Internal Thoracic Artery grafts during primary isolated bypass operations for multivessel coronary disease between 1971 and 1989, we identified 1152 propensity-matched pairs. Mean follow-up of survivors was 16.5 years, with 51 patients followed for 20 years or more. Hazard function methodology was used to identify risk factors for mortality, compare survival, and assess magnitude of benefit. Results Comparison of the matched pairs showed survival of the bilateral Internal Thoracic Artery and single Internal Thoracic Artery groups at 7, 10, 15, and 20 years was 89% versus 87%, 81% versus 78%, 67% versus 58%, and 50% versus 37%, respectively ( p Conclusions Bilateral Internal Thoracic Artery grafting produces improved survival compared with single Internal Thoracic Artery grafting during the second postoperative decade, and the magnitude of that benefit increases through 20 postoperative years.
Joseph F. Sabik - One of the best experts on this subject based on the ideXlab platform.
-
Role of Internal Thoracic Artery Grafts in Reoperative Coronary Artery Bypass Surgery
Arterial Grafting for Coronary Artery Bypass Surgery, 2020Co-Authors: Joseph F. Sabik, Bruce W. LytleAbstract:Coronary reoperations can be performed safely with Internal Thoracic Artery grafts. There does not appear to be any increased perioperative risk in patients undergoing reoperation who have had prior Internal Thoracic Artery grafting, or in patients having single or bilateral Internal Thoracic Artery grafting at reoperation. Some observational studies demonstrate a decreased hospital risk in patients undergoing reoperative coronary surgery who have had prior Internal Thoracic Artery grafting. This may be due to the excellent long termpatency of Internal Thoracic Artery grafts and how this preserves ventricular function. There is also some evidence that Internal Thoracic Artery grafting at reoperation improves long term survival as compared to a reoperative strategy of only saphenous vein grafting.
-
decision making for patients with patent left Internal Thoracic Artery grafts to left anterior descending
The Annals of Thoracic Surgery, 2009Co-Authors: Sreekumar Subramanian, Eugene H. Blackstone, Joseph F. Sabik, Penny L Houghtaling, Edward R Nowicki, Bruce W. LytleAbstract:Background It is unknown whether coronary reintervention confers a survival advantage when a previously placed left Internal Thoracic Artery graft to the left anterior descending coronary Artery (LAD) is patent. We compared survival after medical therapy, percutaneous intervention, and reoperative coronary Artery bypass grafting in such patients who developed non-LAD territory jeopardy. Methods From 1971 to 2000, 4,640 patients with prior coronary Artery bypass grafting that included left Internal Thoracic Artery to LAD grafting were found on angiography during active follow-up to have a patent left Internal Thoracic Artery to LAD graft, but at least 50% stenosis of non-LAD territories or grafts to them. Two survival analyses were performed: (1) intent-to-treat, which included patients undergoing reoperative coronary Artery bypass grafting (n = 731) or percutaneous intervention (n = 994) within 6 weeks of angiography or medical management (n = 2,782), and (2) competing risk/crossover, in which patients were classified as medically managed until crossover to coronary Artery bypass grafting or percutaneous intervention. Results In the intent-to-treat analysis, propensity-adjusted early ( p ≤ 0.05). In the competing risk/crossover analysis, adjusted survival was best for medically treated patients early; however, late survival was similar among all three groups. Conclusions Patients with patent left Internal Thoracic Artery to LAD grafts who develop non-LAD territory jeopardy derive no survival benefit from reintervention, consistent with previous observations that for coronary reintervention to improve survival, the LAD territory must be jeopardized. Reintervention in patients with a patent left Internal Thoracic Artery to LAD graft may be warranted to relieve symptoms, without expecting a survival benefit.
-
Does use of a right Internal Thoracic Artery increase deep wound infection and risk after previous use of a left Internal Thoracic Artery
The Journal of Thoracic and Cardiovascular Surgery, 2006Co-Authors: Lars G. Svensson, Mubashir A. Mumtaz, Eugene H. Blackstone, Jingyuan Feng, Michael K. Banbury, Joseph F. Sabik, B. Gosta Pettersson, Steven M. Gordon, Bruce W. LytleAbstract:Objective To determine whether adding right Internal Thoracic Artery to previous left Internal Thoracic Artery bypass at reoperation increases deep sternal wound infection and hospital mortality, particularly in diabetic patients. Methods Reoperations (n = 2875; 2381 men) in patients with previous left Internal Thoracic Artery bypass were performed between January 1990 and January 2003; 1939 (67%) had no repeat Internal Thoracic Artery grafting, 923 (32%) received an additional right Internal Thoracic Artery graft, and 13 (0.5%) had bilateral Internal Thoracic Artery grafting with reuse of the left Internal Thoracic Artery. Of the patients, 352 (12%) were insulin-treated and 590 (21%) non–insulin-treated diabetics. Multivariable logistic regression analysis was used to identify preoperative variables associated with right versus non–right Internal Thoracic Artery use in diabetics and nondiabetics and to formulate propensity models. Propensity scores were used for matching and adjusted multivariable analyses of deep wound infection and hospital mortality. Results Deep wound infection occurred in 3.0% (7/230) of diabetics receiving right Internal Thoracic Artery grafts, 2.2% (5/230) of propensity-matched diabetics receiving non–right Internal Thoracic Artery grafts ( P = . 6), in 1.1% (6/538) of nondiabetics receiving right Internal Thoracic Artery grafts, and in 1.0% (5/538) of matched non-diabetic patients receiving non–right Internal Thoracic Artery grafts ( P = . 8). Corresponding hospital mortality in these matched groups was 1.7% (4/230) versus 6.1% (14/230) for diabetics ( P = . 02) and 2.6% (14/538) versus 3.5% (19/538) for nondiabetics ( P = . 4). Risk factors for deep wound infection included higher weight ( P = . 0003), higher New York Heart Association functional class ( P = . 03), and less severe left anterior descending disease ( P = . 03). Risk factors for death were ( P Conclusions Use of the right Internal Thoracic Artery for reoperations does not increase the risk of deep wound infections in diabetics or nondiabetics and does not increase mortality.
-
comparison of saphenous vein and Internal Thoracic Artery graft patency by coronary system
The Annals of Thoracic Surgery, 2005Co-Authors: Joseph F. Sabik, Eugene H. Blackstone, Bruce W. Lytle, Penny L Houghtaling, Delos M CosgroveAbstract:Background We sought to compare saphenous vein and Internal Thoracic Artery graft patency by coronary system. Methods From 1972 to 1999, 50,278 patients underwent primary coronary surgery; subsequently, 4,333 had angiography of 2,121 Internal Thoracic Artery and 8,733 saphenous vein grafts. Longitudinal analysis was used to model graft occlusion and identify risk factors. Using the model, patency was calculated twice for each graft and compared first as if an Internal Thoracic Artery, and second as if a saphenous vein, were used. Results Unadjusted 1-, 5-, and 10-year patency was 93%, 88%, and 90% for Internal Thoracic arteries and 78%, 65%, and 57% for saphenous veins. At 10 years, Internal Thoracic arteries were more likely than saphenous veins to be patent to left anterior descending in 99.1% of cases, to diagonals in 98.3%, to circumflex in 98.3%, to posterior descending Artery in 98.5%, and to right coronary arteries in 82.5%. For right coronary arteries, saphenous vein patency was equivalent to or better than Internal Thoracic Artery patency early after surgery. However, by 10 years, Internal Thoracic Artery patency was better in right coronary arteries with 70% stenosis or greater. At all times after surgery and all levels of clinically important coronary stenosis, Internal Thoracic Artery patency surpassed saphenous vein patency in grafts to the left anterior descending, diagonal, circumflex, and posterior descending arteries. Conclusions Internal Thoracic arteries demonstrate better patency than saphenous veins except when grafting moderately stenosed right coronary arteries. When bypassing right coronary arteries with less than 70% stenosis, saphenous veins may be a better choice.
-
the effect of bilateral Internal Thoracic Artery grafting on survival during 20 postoperative years
The Annals of Thoracic Surgery, 2004Co-Authors: Bruce W. Lytle, Eugene H. Blackstone, Joseph F. Sabik, F. D. Loop, Penny L Houghtaling, Delos M CosgroveAbstract:Background To compare survival of patients receiving bilateral Internal Thoracic Artery grafts and single Internal Thoracic Artery grafts more than 20 postoperative years, assess magnitude of benefit, and identify predictors of benefit. Methods From cohorts of 8123 patients receiving single Internal Thoracic Artery grafts and 2001 receiving bilateral Internal Thoracic Artery grafts during primary isolated bypass operations for multivessel coronary disease between 1971 and 1989, we identified 1152 propensity-matched pairs. Mean follow-up of survivors was 16.5 years, with 51 patients followed for 20 years or more. Hazard function methodology was used to identify risk factors for mortality, compare survival, and assess magnitude of benefit. Results Comparison of the matched pairs showed survival of the bilateral Internal Thoracic Artery and single Internal Thoracic Artery groups at 7, 10, 15, and 20 years was 89% versus 87%, 81% versus 78%, 67% versus 58%, and 50% versus 37%, respectively ( p Conclusions Bilateral Internal Thoracic Artery grafting produces improved survival compared with single Internal Thoracic Artery grafting during the second postoperative decade, and the magnitude of that benefit increases through 20 postoperative years.
Delos M Cosgrove - One of the best experts on this subject based on the ideXlab platform.
-
comparison of saphenous vein and Internal Thoracic Artery graft patency by coronary system
The Annals of Thoracic Surgery, 2005Co-Authors: Joseph F. Sabik, Eugene H. Blackstone, Bruce W. Lytle, Penny L Houghtaling, Delos M CosgroveAbstract:Background We sought to compare saphenous vein and Internal Thoracic Artery graft patency by coronary system. Methods From 1972 to 1999, 50,278 patients underwent primary coronary surgery; subsequently, 4,333 had angiography of 2,121 Internal Thoracic Artery and 8,733 saphenous vein grafts. Longitudinal analysis was used to model graft occlusion and identify risk factors. Using the model, patency was calculated twice for each graft and compared first as if an Internal Thoracic Artery, and second as if a saphenous vein, were used. Results Unadjusted 1-, 5-, and 10-year patency was 93%, 88%, and 90% for Internal Thoracic arteries and 78%, 65%, and 57% for saphenous veins. At 10 years, Internal Thoracic arteries were more likely than saphenous veins to be patent to left anterior descending in 99.1% of cases, to diagonals in 98.3%, to circumflex in 98.3%, to posterior descending Artery in 98.5%, and to right coronary arteries in 82.5%. For right coronary arteries, saphenous vein patency was equivalent to or better than Internal Thoracic Artery patency early after surgery. However, by 10 years, Internal Thoracic Artery patency was better in right coronary arteries with 70% stenosis or greater. At all times after surgery and all levels of clinically important coronary stenosis, Internal Thoracic Artery patency surpassed saphenous vein patency in grafts to the left anterior descending, diagonal, circumflex, and posterior descending arteries. Conclusions Internal Thoracic arteries demonstrate better patency than saphenous veins except when grafting moderately stenosed right coronary arteries. When bypassing right coronary arteries with less than 70% stenosis, saphenous veins may be a better choice.
-
the effect of bilateral Internal Thoracic Artery grafting on survival during 20 postoperative years
The Annals of Thoracic Surgery, 2004Co-Authors: Bruce W. Lytle, Eugene H. Blackstone, Joseph F. Sabik, F. D. Loop, Penny L Houghtaling, Delos M CosgroveAbstract:Background To compare survival of patients receiving bilateral Internal Thoracic Artery grafts and single Internal Thoracic Artery grafts more than 20 postoperative years, assess magnitude of benefit, and identify predictors of benefit. Methods From cohorts of 8123 patients receiving single Internal Thoracic Artery grafts and 2001 receiving bilateral Internal Thoracic Artery grafts during primary isolated bypass operations for multivessel coronary disease between 1971 and 1989, we identified 1152 propensity-matched pairs. Mean follow-up of survivors was 16.5 years, with 51 patients followed for 20 years or more. Hazard function methodology was used to identify risk factors for mortality, compare survival, and assess magnitude of benefit. Results Comparison of the matched pairs showed survival of the bilateral Internal Thoracic Artery and single Internal Thoracic Artery groups at 7, 10, 15, and 20 years was 89% versus 87%, 81% versus 78%, 67% versus 58%, and 50% versus 37%, respectively ( p Conclusions Bilateral Internal Thoracic Artery grafting produces improved survival compared with single Internal Thoracic Artery grafting during the second postoperative decade, and the magnitude of that benefit increases through 20 postoperative years.
David P Taggart - One of the best experts on this subject based on the ideXlab platform.
-
incidence and clinical implications of intraoperative bilateral Internal Thoracic Artery graft conversion insights from the arterial revascularization trial
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Umberto Benedetto, D G Altman, Alastair Gray, B Lees, Stephen Gerry, Marcus Flather, David P TaggartAbstract:Abstract 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 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.
-
randomized trial of bilateral versus single Internal Thoracic Artery grafts
The New England Journal of Medicine, 2016Co-Authors: David P Taggart, D G Altman, Alastair Gray, B Lees, Stephen Gerry, Umberto Benedetto, Marcus FlatherAbstract:BackgroundThe use of bilateral Internal Thoracic (mammary) arteries for coronary-Artery bypass grafting (CABG) may improve long-term outcomes as compared with the use of a single Internal-Thoracic-Artery plus vein grafts. MethodsWe randomly assigned patients scheduled for CABG to undergo single or bilateral Internal-Thoracic-Artery grafting in 28 cardiac surgical centers in seven countries. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome. Interim analyses were prespecified at 5 years of follow-up. ResultsA total of 3102 patients were enrolled; 1554 were randomly assigned to undergo single Internal-Thoracic-Artery grafting (the single-graft group) and 1548 to undergo bilateral Internal-Thoracic-Artery grafting (the bilateral-graft group). At 5 years of follow-up, the rate of death was 8.7% in the bilateral-graft group and 8.4% in the single-graft group (hazard ratio, 1.04; 95% confidence interval [CI],...
-
pedicled and skeletonized single and bilateral Internal Thoracic Artery grafts and the incidence of sternal wound complications insights from the arterial revascularization trial
The Journal of Thoracic and Cardiovascular Surgery, 2016Co-Authors: Umberto Benedetto, D G Altman, Alastair Gray, B Lees, Stephen Gerry, Marcus Flather, Rafal Pawlaczyk, David P TaggartAbstract:Abstract Objectives The question of whether skeletonized Internal Thoracic Artery harvesting reduces the incidence of sternal wound complications in comparison with the pedicled technique, in the context of single or bilateral Internal Thoracic arteries, remains controversial. We studied the impact of the Internal Thoracic Artery harvesting strategy on sternal wound complication in the Arterial Revascularization Trial. Methods Patients enrolled in the Arterial Revascularization Trial (n = 3102) were randomized to coronary Artery bypass grafting with single or bilateral Internal Thoracic arteries. Sternal wound complication rates were examined according to the harvesting technique that was documented in 2056 patients. The Internal Thoracic Artery harvesting technique, based on the surgeon's preference, resulted in 4 groups: pedicled single Internal Thoracic Artery (n = 607), pedicled bilateral Internal Thoracic Artery (n = 459), skeletonized single Internal Thoracic Artery (n = 512), and skeletonized bilateral Internal Thoracic Artery (n = 478). Propensity scores weighting was used to estimate the impact of the harvesting technique on sternal wound complications. Results A total of 219 of 2056 patients (10.6%) experienced a sternal wound complication within 1 year from the index operation. Of those, only 25 patients (1.2%) required sternal wound reconstruction. Pedicled bilateral Internal Thoracic Artery (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.23-2.63) but not skeletonized bilateral Internal Thoracic Artery (OR, 1.00; 95% CI, 0.65-1.53) or skeletonized single Internal Thoracic Artery (OR, 0.89; 95% CI, 0.57-1.38) was associated with a significantly increased risk of any sternal wound complications compared with pedicled single Internal Thoracic Artery. Conclusions The present Arterial Revascularization Trial substudy suggests that, with a skeletonization technique, the risk of sternal wound complication with bilateral Internal Thoracic Artery grafting is similar to that after standard pedicled single Internal Thoracic Artery harvesting, whereas skeletonized single Internal Thoracic Artery harvesting did not add any further benefit when compared with pedicled single Internal Thoracic Artery harvesting.
Eugene H. Blackstone - One of the best experts on this subject based on the ideXlab platform.
-
decision making for patients with patent left Internal Thoracic Artery grafts to left anterior descending
The Annals of Thoracic Surgery, 2009Co-Authors: Sreekumar Subramanian, Eugene H. Blackstone, Joseph F. Sabik, Penny L Houghtaling, Edward R Nowicki, Bruce W. LytleAbstract:Background It is unknown whether coronary reintervention confers a survival advantage when a previously placed left Internal Thoracic Artery graft to the left anterior descending coronary Artery (LAD) is patent. We compared survival after medical therapy, percutaneous intervention, and reoperative coronary Artery bypass grafting in such patients who developed non-LAD territory jeopardy. Methods From 1971 to 2000, 4,640 patients with prior coronary Artery bypass grafting that included left Internal Thoracic Artery to LAD grafting were found on angiography during active follow-up to have a patent left Internal Thoracic Artery to LAD graft, but at least 50% stenosis of non-LAD territories or grafts to them. Two survival analyses were performed: (1) intent-to-treat, which included patients undergoing reoperative coronary Artery bypass grafting (n = 731) or percutaneous intervention (n = 994) within 6 weeks of angiography or medical management (n = 2,782), and (2) competing risk/crossover, in which patients were classified as medically managed until crossover to coronary Artery bypass grafting or percutaneous intervention. Results In the intent-to-treat analysis, propensity-adjusted early ( p ≤ 0.05). In the competing risk/crossover analysis, adjusted survival was best for medically treated patients early; however, late survival was similar among all three groups. Conclusions Patients with patent left Internal Thoracic Artery to LAD grafts who develop non-LAD territory jeopardy derive no survival benefit from reintervention, consistent with previous observations that for coronary reintervention to improve survival, the LAD territory must be jeopardized. Reintervention in patients with a patent left Internal Thoracic Artery to LAD graft may be warranted to relieve symptoms, without expecting a survival benefit.
-
Does use of a right Internal Thoracic Artery increase deep wound infection and risk after previous use of a left Internal Thoracic Artery
The Journal of Thoracic and Cardiovascular Surgery, 2006Co-Authors: Lars G. Svensson, Mubashir A. Mumtaz, Eugene H. Blackstone, Jingyuan Feng, Michael K. Banbury, Joseph F. Sabik, B. Gosta Pettersson, Steven M. Gordon, Bruce W. LytleAbstract:Objective To determine whether adding right Internal Thoracic Artery to previous left Internal Thoracic Artery bypass at reoperation increases deep sternal wound infection and hospital mortality, particularly in diabetic patients. Methods Reoperations (n = 2875; 2381 men) in patients with previous left Internal Thoracic Artery bypass were performed between January 1990 and January 2003; 1939 (67%) had no repeat Internal Thoracic Artery grafting, 923 (32%) received an additional right Internal Thoracic Artery graft, and 13 (0.5%) had bilateral Internal Thoracic Artery grafting with reuse of the left Internal Thoracic Artery. Of the patients, 352 (12%) were insulin-treated and 590 (21%) non–insulin-treated diabetics. Multivariable logistic regression analysis was used to identify preoperative variables associated with right versus non–right Internal Thoracic Artery use in diabetics and nondiabetics and to formulate propensity models. Propensity scores were used for matching and adjusted multivariable analyses of deep wound infection and hospital mortality. Results Deep wound infection occurred in 3.0% (7/230) of diabetics receiving right Internal Thoracic Artery grafts, 2.2% (5/230) of propensity-matched diabetics receiving non–right Internal Thoracic Artery grafts ( P = . 6), in 1.1% (6/538) of nondiabetics receiving right Internal Thoracic Artery grafts, and in 1.0% (5/538) of matched non-diabetic patients receiving non–right Internal Thoracic Artery grafts ( P = . 8). Corresponding hospital mortality in these matched groups was 1.7% (4/230) versus 6.1% (14/230) for diabetics ( P = . 02) and 2.6% (14/538) versus 3.5% (19/538) for nondiabetics ( P = . 4). Risk factors for deep wound infection included higher weight ( P = . 0003), higher New York Heart Association functional class ( P = . 03), and less severe left anterior descending disease ( P = . 03). Risk factors for death were ( P Conclusions Use of the right Internal Thoracic Artery for reoperations does not increase the risk of deep wound infections in diabetics or nondiabetics and does not increase mortality.
-
comparison of saphenous vein and Internal Thoracic Artery graft patency by coronary system
The Annals of Thoracic Surgery, 2005Co-Authors: Joseph F. Sabik, Eugene H. Blackstone, Bruce W. Lytle, Penny L Houghtaling, Delos M CosgroveAbstract:Background We sought to compare saphenous vein and Internal Thoracic Artery graft patency by coronary system. Methods From 1972 to 1999, 50,278 patients underwent primary coronary surgery; subsequently, 4,333 had angiography of 2,121 Internal Thoracic Artery and 8,733 saphenous vein grafts. Longitudinal analysis was used to model graft occlusion and identify risk factors. Using the model, patency was calculated twice for each graft and compared first as if an Internal Thoracic Artery, and second as if a saphenous vein, were used. Results Unadjusted 1-, 5-, and 10-year patency was 93%, 88%, and 90% for Internal Thoracic arteries and 78%, 65%, and 57% for saphenous veins. At 10 years, Internal Thoracic arteries were more likely than saphenous veins to be patent to left anterior descending in 99.1% of cases, to diagonals in 98.3%, to circumflex in 98.3%, to posterior descending Artery in 98.5%, and to right coronary arteries in 82.5%. For right coronary arteries, saphenous vein patency was equivalent to or better than Internal Thoracic Artery patency early after surgery. However, by 10 years, Internal Thoracic Artery patency was better in right coronary arteries with 70% stenosis or greater. At all times after surgery and all levels of clinically important coronary stenosis, Internal Thoracic Artery patency surpassed saphenous vein patency in grafts to the left anterior descending, diagonal, circumflex, and posterior descending arteries. Conclusions Internal Thoracic arteries demonstrate better patency than saphenous veins except when grafting moderately stenosed right coronary arteries. When bypassing right coronary arteries with less than 70% stenosis, saphenous veins may be a better choice.
-
the effect of bilateral Internal Thoracic Artery grafting on survival during 20 postoperative years
The Annals of Thoracic Surgery, 2004Co-Authors: Bruce W. Lytle, Eugene H. Blackstone, Joseph F. Sabik, F. D. Loop, Penny L Houghtaling, Delos M CosgroveAbstract:Background To compare survival of patients receiving bilateral Internal Thoracic Artery grafts and single Internal Thoracic Artery grafts more than 20 postoperative years, assess magnitude of benefit, and identify predictors of benefit. Methods From cohorts of 8123 patients receiving single Internal Thoracic Artery grafts and 2001 receiving bilateral Internal Thoracic Artery grafts during primary isolated bypass operations for multivessel coronary disease between 1971 and 1989, we identified 1152 propensity-matched pairs. Mean follow-up of survivors was 16.5 years, with 51 patients followed for 20 years or more. Hazard function methodology was used to identify risk factors for mortality, compare survival, and assess magnitude of benefit. Results Comparison of the matched pairs showed survival of the bilateral Internal Thoracic Artery and single Internal Thoracic Artery groups at 7, 10, 15, and 20 years was 89% versus 87%, 81% versus 78%, 67% versus 58%, and 50% versus 37%, respectively ( p Conclusions Bilateral Internal Thoracic Artery grafting produces improved survival compared with single Internal Thoracic Artery grafting during the second postoperative decade, and the magnitude of that benefit increases through 20 postoperative years.