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Off-pump Bilateral Skeletonized Internal Thoracic Artery Grafting in Elderly Patients.
MedLine Citation:
PMID:  22197616     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The purpose of the present study was to compare outcome in propensity score-matched patients, aged 70 years or greater, undergoing isolated off-pump coronary bypass surgery using a bilateral (BITA) or single (SITA) skeletonized internal thoracic artery. METHODS: Of 912 consecutive patients undergoing isolated coronary bypass grafting (906 using the off-pump technique without emergent conversion to cardiopulmonary bypass), the 491 aged 70 years or greater undergoing off-pump skeletonized single (n = 247) or bilateral (n = 244) skeletonized internal thoracic artery grafting were retrospectively analyzed after excluding the 6 who were transferred to our hospital after receiving percutaneous cardiopulmonary bypass, the 72 who had only 1 target in the left coronary area, and the 343 aged less than 70 years. A total of 217 pairs were matched using propensity scores calculated from 9 preoperative factors (0.69). RESULTS: The rate of postoperative complications was similar between the groups. The 5-year estimated survival free from overall death and cardiac event, respectively, in the BITA group versus the SITA group were 86.4% ± 3.2% versus 73.5% ± 3.9% (p = 0.01) and 93.2% ± 2.7% versus 87.5% ± 3.0% (p = 0.01). In multivariate Cox models, bilateral internal thoracic artery grafting was significantly associated with a lower risk of overall death (hazard ratio 0.56; 95% confidence interval 0.31 to 0.99; p = 0.04) and cardiac event (hazard ratio 0.36; 95% confidence interval 0.15 to 0.88; p = 0.03). CONCLUSIONS: In elderly patients, off-pump in situ left-sided bilateral skeletonized internal thoracic artery grafting is associated with lower risk of overall death and cardiac event than single internal thoracic artery grafting and carries no increased operative risk.
Authors:
Takeshi Kinoshita; Tohru Asai; Tomoaki Suzuki; Satoshi Kuroyanagi; Soh Hosoba; Noriyuki Takashima
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-23
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  -     ISSN:  1552-6259     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan.
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