| Total arterial myocardial revascularization with composite grafts improves results of coronary surgery in elderly: a prospective randomized comparison with conventional coronary artery bypass surgery. | |
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MedLine Citation:
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PMID: 12970204 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Total arterial myocardial revascularization with composite grafts proved to enhance the long-term benefits of coronary surgery. We assessed the hypothesis that full arterial revascularization (FAR) may improve clinical outcome even in elderly and at short term. METHODS AND RESULTS: A prospective randomized study was designed to compare FAR with conventional coronary artery bypass grafting (CABG) surgery [left interval thoracic artery (LITA) on left anterior descending (LAD) plus additional saphenous vein grafts] with the following end points: early and late death, graft occlusion, reintervention, angina recurrence, and acute myocardial infarction (AMI). We enrolled 200 consecutive patients >70 years of age; population was equally divided at random in Group 1 (G1, FAR) and Group 2 (G2, Conventional). The groups resulted comparable with respect to all preoperative continuous and discrete variables and risk factors (Euroscore: G1=8.4 versus G2=8.1). No differences between G1 versus G2 were observed in terms of postoperative complications (perioperative AMI:2% versus 3%), mean intensive care unit (ICU) (hours: 39+/-11 versus 40+/-9) and hospital stay (days: 6+/-2 versus 7+/-3) nor were there any differences in hospital mortality(G1=5% versus G2=4%). At the mean follow-up of 14+/-5 months the incidence of angina recurrence was 3% in G1 versus 12% in G2. Angiographic controls of grafts showed a superior graft patency rate of all the arterial grafts when compared with saphenous vein grafts. Conventional CABG surgery was identified as incremental risk factor for angina recurrence and as predictor for graft occlusion. CONCLUSIONS: Total arterial myocardial revascularization improved clinical outcome of patients undergoing coronary surgery in the elderly, whereas saphenous vein grafts negatively affected patient prognosis in terms of graft patency and freedom from late cardiac events. |
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Authors:
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Claudio Muneretto; Gianluigi Bisleri; Alberto Negri; Jacopo Manfredi; Marco Metra; Savina Nodari; Lidia Culot; Livio Dei Cas |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Circulation Volume: 108 Suppl 1 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2003 Sep |
Date Detail:
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Created Date: 2003-09-12 Completed Date: 2003-09-30 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: II29-33 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy. munerett@master.cci.unibs.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Coronary Artery Bypass / adverse effects, methods* Disease-Free Survival Female Follow-Up Studies Humans Male Saphenous Vein / transplantation Thoracic Arteries / transplantation Treatment Outcome |
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