Bilateral Versus Single Internal Mammary Artery Use in Coronary Artery Bypass Grafting: A Propensity Matched Analysis.

Coronary Artery Bypass / methods Coronary Artery Disease / surgery Humans Mammary Arteries / transplantation Morbidity / trends New South Wales / epidemiology Postoperative Complications / epidemiology Propensity Score Retrospective Studies Risk Factors Survival Rate / trends
Arterial revascularisation Coronary artery bypass surgery Deep sternal wound infection

Journal

Heart, lung & circulation
ISSN: 1444-2892
Titre abrégé: Heart Lung Circ
Pays: Australia
ID NLM: 100963739

Informations de publication

Date de publication:
May 2019
Historique:
received: 31 12 2017
revised: 18 03 2018
accepted: 23 03 2018
pubmed: 22 8 2018
medline: 13 4 2019
entrez: 22 8 2018
Statut: ppublish

Résumé

Bilateral internal mammary artery (BIMA) grafts have demonstrated superior long-term outcomes compared with single internal mammary artery (SIMA) grafts. Despite this, BIMA remains widely underutilised due to perceived technical challenges and concerns regarding wound healing. We sought to examine the morbidity and mortality associated with BIMA use in a propensity-matched cohort of patients. From 2009 to 2016, 3,594 consecutive patients underwent coronary artery bypass surgery at three affiliated institutions. Thirty-day (30) mortality and morbidity data were collected prospectively. Propensity-score matched analyses were performed for BIMA versus SIMA use controlling for a number of preoperative characteristics. Overall, 29% of procedures were performed off pump, with a greater proportion in the BIMA group (43% vs. 21%, p<0.001). In the propensity-score analysis consisting of 820 matched pairs, there were similar rates of 30-day mortality (1.3% BIMA vs. 0.9% SIMA, p=0.48) and deep sternal wound infection (1.1% BIMA vs. 0.9% SIMA, p=0.84). The rate of superficial sternal wound infection trended towards being higher in the BIMA group (2.6% vs. 1.3%, p=0.077). The rates of red blood cell transfusions (27.4% vs. 27%, p=0.217), other blood product transfusions (18% vs. 20%, p=0.217), and reoperation for bleeding (2.9% vs. 2.1%, p=0.349) were similar. Bilateral internal mammary artery use was associated with similar rates of deep sternal wound infection compared to SIMA use, with a preponderance of superficial sternal wound infections that did not result in increased mortality or transfusion requirements. The use of BIMA should be more widely considered for coronary artery bypass surgery.

Sections du résumé

BACKGROUND BACKGROUND
Bilateral internal mammary artery (BIMA) grafts have demonstrated superior long-term outcomes compared with single internal mammary artery (SIMA) grafts. Despite this, BIMA remains widely underutilised due to perceived technical challenges and concerns regarding wound healing. We sought to examine the morbidity and mortality associated with BIMA use in a propensity-matched cohort of patients.
METHODS METHODS
From 2009 to 2016, 3,594 consecutive patients underwent coronary artery bypass surgery at three affiliated institutions. Thirty-day (30) mortality and morbidity data were collected prospectively. Propensity-score matched analyses were performed for BIMA versus SIMA use controlling for a number of preoperative characteristics.
RESULTS RESULTS
Overall, 29% of procedures were performed off pump, with a greater proportion in the BIMA group (43% vs. 21%, p<0.001). In the propensity-score analysis consisting of 820 matched pairs, there were similar rates of 30-day mortality (1.3% BIMA vs. 0.9% SIMA, p=0.48) and deep sternal wound infection (1.1% BIMA vs. 0.9% SIMA, p=0.84). The rate of superficial sternal wound infection trended towards being higher in the BIMA group (2.6% vs. 1.3%, p=0.077). The rates of red blood cell transfusions (27.4% vs. 27%, p=0.217), other blood product transfusions (18% vs. 20%, p=0.217), and reoperation for bleeding (2.9% vs. 2.1%, p=0.349) were similar.
CONCLUSIONS CONCLUSIONS
Bilateral internal mammary artery use was associated with similar rates of deep sternal wound infection compared to SIMA use, with a preponderance of superficial sternal wound infections that did not result in increased mortality or transfusion requirements. The use of BIMA should be more widely considered for coronary artery bypass surgery.

Identifiants

DOI: 10.1016/j.hlc.2018.03.022 PMID: 30126790
pubmed: 30126790
pii: S1443-9506(18)30138-0
doi: 10.1016/j.hlc.2018.03.022
pii:
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

807-813

Informations de copyright

Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

Auteurs

Ying Yan Zhu (YY)

The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, NSW, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia. Electronic address: yingyan.zhu@gmail.com.

Michael Seco (M)

Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, NSW, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Stella R Harris (SR)

Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, NSW, Australia.

Michalis Koullouros (M)

Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, NSW, Australia.

Fabio Ramponi (F)

The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, NSW, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Michael Wilson (M)

The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, NSW, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney, NSW, Australia.

Paul G Bannon (PG)

The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, NSW, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney, NSW, Australia.

Michael P Vallely (MP)

The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, NSW, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Procédures de chirurgie cardiaque › Revascularisation myocardique › Pontage aortocoronarien › Bilateral Versus Single Internal Mammary...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Ischémie myocardique › Maladie coronarienne › Maladie des artères coronaires › Bilateral Versus Single Internal Mammary...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Bilateral Versus Single Internal Mammary...
questionsmedicales.fr › Système cardiovasculaire › Vaisseaux sanguins › Artères › Artères thoraciques › Artères mammaires › Bilateral Versus Single Internal Mammary...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › Bilateral Versus Single Internal Mammary...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › Nouvelle-Galles du Sud › Bilateral Versus Single Internal Mammary...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Bilateral Versus Single Internal Mammary...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Score de propension › Bilateral Versus Single Internal Mammary...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Bilateral Versus Single Internal Mammary...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Bilateral Versus Single Internal Mammary...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Taux de survie › Bilateral Versus Single Internal Mammary...