Patency of conduits in patients who received internal mammary artery, radial artery and saphenous vein grafts.
Aged
Aged, 80 and over
Coronary Angiography
Coronary Artery Bypass
/ adverse effects
Coronary Artery Disease
/ surgery
Female
Graft Occlusion, Vascular
/ diagnostic imaging
Humans
Male
Mammary Arteries
/ diagnostic imaging
Middle Aged
Prospective Studies
Radial Artery
/ diagnostic imaging
Risk Factors
Saphenous Vein
/ diagnostic imaging
Time Factors
Treatment Outcome
Vascular Patency
(Max 10) patency
Arterial
Internal mammary artery
Radial artery
Saphenous vein
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
24 03 2020
24 03 2020
Historique:
received:
17
06
2019
accepted:
13
03
2020
entrez:
25
3
2020
pubmed:
25
3
2020
medline:
1
12
2020
Statut:
epublish
Résumé
Where each patient has all three conduits of internal mammary artery (IMA), saphenous vein graft (SVG) and radial artery (RA), most confounders affecting comparison between conduits can be mitigated. Additionally, since SVG progressively fails over time, restricting patient angiography to the late period only can mitigate against early SVG patency that may have occluded in the late period. Research protocol driven conventional angiography was performed for patients with at least one of each conduit of IMA, RA and SVG and a minimum of 7 years postoperative. The primary analysis was perfect patency and secondary analysis was overall patency including angiographic evidence of conduit lumen irregularity from conduit atheroma. Multivariable generalized linear mixed model (GLMM) was used. Patency excluded occluded or "string sign" conduits. Perfect patency was present in patent grafts if there was no lumen irregularity. Fifty patients underwent coronary angiography at overall duration postoperative 13.1 ± 2.9, and age 74.3 ± 7.0 years. Of 196 anastomoses, IMA 62, RA 77 and SVG 57. Most IMA were to the left anterior descending territory and most RA and SVG were to the circumflex and right coronary territories. Perfect patency RA 92.2% was not different to IMA 96.8%, P = 0.309; and both were significantly better than SVG 17.5%, P < 0.001. Patency RA 93.5% was also not different to IMA 96.8%, P = 0.169, and both arterial conduits were significantly higher than SVG 82.5%, P = 0.029. Grafting according to coronary territory was not significant for perfect patency, P = 0.997 and patency P = 0.289. Coronary stenosis predicted perfect patency for RA only, P = 0.030 and for patency, RA, P = 0.007, and SVG, P = 0.032. When both arterial conduits were combined, perfect patency, P < 0.001, and patency, P = 0.017, were superior to SVG. All but one patent internal mammary artery or radial artery grafts had perfect patency and had superior perfect patency and overall patency compared to saphenous vein grafts.
Sections du résumé
BACKGROUND
Where each patient has all three conduits of internal mammary artery (IMA), saphenous vein graft (SVG) and radial artery (RA), most confounders affecting comparison between conduits can be mitigated. Additionally, since SVG progressively fails over time, restricting patient angiography to the late period only can mitigate against early SVG patency that may have occluded in the late period.
METHODS
Research protocol driven conventional angiography was performed for patients with at least one of each conduit of IMA, RA and SVG and a minimum of 7 years postoperative. The primary analysis was perfect patency and secondary analysis was overall patency including angiographic evidence of conduit lumen irregularity from conduit atheroma. Multivariable generalized linear mixed model (GLMM) was used. Patency excluded occluded or "string sign" conduits. Perfect patency was present in patent grafts if there was no lumen irregularity.
RESULTS
Fifty patients underwent coronary angiography at overall duration postoperative 13.1 ± 2.9, and age 74.3 ± 7.0 years. Of 196 anastomoses, IMA 62, RA 77 and SVG 57. Most IMA were to the left anterior descending territory and most RA and SVG were to the circumflex and right coronary territories. Perfect patency RA 92.2% was not different to IMA 96.8%, P = 0.309; and both were significantly better than SVG 17.5%, P < 0.001. Patency RA 93.5% was also not different to IMA 96.8%, P = 0.169, and both arterial conduits were significantly higher than SVG 82.5%, P = 0.029. Grafting according to coronary territory was not significant for perfect patency, P = 0.997 and patency P = 0.289. Coronary stenosis predicted perfect patency for RA only, P = 0.030 and for patency, RA, P = 0.007, and SVG, P = 0.032. When both arterial conduits were combined, perfect patency, P < 0.001, and patency, P = 0.017, were superior to SVG.
CONCLUSIONS
All but one patent internal mammary artery or radial artery grafts had perfect patency and had superior perfect patency and overall patency compared to saphenous vein grafts.
Identifiants
pubmed: 32204693
doi: 10.1186/s12872-020-01433-0
pii: 10.1186/s12872-020-01433-0
pmc: PMC7092416
doi:
Types de publication
Comparative Study
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
148Références
Eur J Cardiothorac Surg. 2000 Mar;17(3):294-304
pubmed: 10758391
Ann Thorac Surg. 2005 Feb;79(2):544-51; discussion 544-51
pubmed: 15680832
J Thorac Cardiovasc Surg. 2015 Oct;150(4):880-8
pubmed: 26282605
Circulation. 2011 Jul 19;124(3):273-5
pubmed: 21768550
Circulation. 1978 Jun;57(6):1070-74
pubmed: 346259
Eur J Cardiothorac Surg. 1999 Nov;16(5):499-505
pubmed: 10609899
N Engl J Med. 1986 Jan 2;314(1):1-6
pubmed: 3484393
Eur J Cardiothorac Surg. 2018 Dec 1;54(6):1093-1100
pubmed: 29893823
J Am Coll Cardiol. 2018 Oct 16;72(16):1981-1982
pubmed: 30309476
Eur J Cardiothorac Surg. 2012 Jan;41(1):87-92
pubmed: 21900019
Ann Thorac Surg. 2010 Oct;90(4):1165-72
pubmed: 20868808
J Am Coll Cardiol. 2004 Dec 7;44(11):2149-56
pubmed: 15582312
Circulation. 2011 Jul 19;124(3):280-8
pubmed: 21709060
J Am Coll Cardiol. 2018 Sep 18;72(12):1332-1340
pubmed: 30213324
Circulation. 2012 Sep 11;126(11 Suppl 1):S170-5
pubmed: 22965979