| Radial artery conduits improve long-term survival after coronary artery bypass grafting. | |
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MedLine Citation:
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PMID: 20868808 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The second best conduit for coronary artery bypass graft surgery (CABG) is unclear. We sought to determine if the use of a second arterial conduit, the radial artery (RA), would improve long-term survival after CABG using the left internal thoracic artery (LITA) and saphenous vein (SV). METHODS: We compared the 14-year outcomes in propensity-matched patients undergoing isolated, primary CABG using the LITA, RA, and SV versus CABG using the LITA and only SV. In all, 826 patients from each group had similar propensity-matched demographics and multiple variables. The primary endpoint was all-cause mortality obtained using the Social Security Death Index. RESULTS: Perioperative outcomes including in hospital mortality (0.1% for the RA patients and 0.2% for the SV patients) were similar. Kaplan-Meier survival at 1, 5, and 10 years was 98.3%, 93.9%, and 83.1% for the RA group versus 97.2%, 88.7%, and 74.3% for the SV group (log rank, p = 0.0011). Cox proportional hazards models showed a lower all-cause mortality in the RA group (hazard ratio 0.72, confidence interval: 0.56 to 0.92, p = 0.0084). Ten-year survivals showed a 52% increased mortality for the SV patients (25.7%) versus the RA patients (16.9%; p = 0.0011). For symptomatic patients, RA patency was 80.7%, which was not different than the LITA patency rate of 86.4% but was superior to the SV patency rate of 46.7% (p < 0.001). CONCLUSIONS: Using the LITA, SV, and a RA conduit for CABG results in significantly improved long-term survival compared with using the LITA and SV. The use of two arterial conduits offers a clear and lasting survival advantage, likely due to the improved patency of RA grafts. We conclude that RA conduits should be more widely utilized during CABG. |
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Authors:
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Robert F Tranbaugh; Kamellia R Dimitrova; Patricia Friedmann; Charles M Geller; Loren J Harris; Paul Stelzer; Bertram Cohen; Darryl M Hoffman |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 90 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-27 Completed Date: 2010-10-21 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1165-72 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Division of Cardiac Surgery and Office of Grants and Research Administration, Beth Israel Medical Center, New York, New York 10003, USA. rtranbau@chpnet.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Coronary Artery Bypass / methods, mortality* Female Humans Kaplan-Meiers Estimate Male Mammary Arteries / transplantation Middle Aged Propensity Score Radial Artery / transplantation* Retrospective Studies Saphenous Vein / transplantation Tissue and Organ Harvesting / methods Treatment Outcome Vascular Patency |
| Comments/Corrections | |
Comment In:
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Ann Thorac Surg. 2010 Oct;90(4):1172
[PMID:
20868809
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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