JTCS Speed Up Your Browser
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Stevens, L.M.
Right arrow Articles by Pellerin, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Stevens, L.M.
Right arrow Articles by Pellerin, M.
Related Collections
Right arrow Coronary disease

J Thorac Cardiovasc Surg 2004;127:1408-1415
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Single versus bilateral internal thoracic artery grafts with concomitant saphenous vein grafts for multivessel coronary artery bypass grafting: Effects on mortality and event-free survival

L.M. Stevens, MDb, M. Carrier, MDa,b,*, L.P. Perrault, MD, PhDa,b, Y. Hébert, MDb, R. Cartier, MDa,b, D. Bouchard, MDb, A. Fortier, MSca, I. El-Hamamsy, MDb, M. Pellerin, MDa,b

a Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
b Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada

Received for publication August 4, 2003; revisions received September 30, 2003; accepted for publication October 6, 2003.

* Address for reprints: M. Carrier, MD, Department of Surgery, Montreal Heart Institute, 5000 Belanger St East, Montreal, Quebec H1T 1C8, Canada
michel.carrier{at}icm-mhi.org

BACKGROUND: The issue of superiority of single internal thoracic artery grafting versus bilateral internal thoracic artery grafting remains unresolved. The aim of this study was to compare the long-term outcome of single and bilateral internal thoracic artery grafting with concomitant saphenous vein grafting for multivessel coronary artery bypass grafting.

METHODS: Between March 1985 and April 1995, 6650 patients underwent primary isolated coronary artery bypass grafting with internal thoracic artery grafts, including 4382 patients with multivessel bypass grafting requiring at least 3 grafts. Outcomes of patients undergoing single internal thoracic artery plus saphenous vein grafting (n = 2547) and bilateral internal thoracic artery plus saphenous vein grafting (n = 1835) were obtained at a mean follow-up of 11 ± 3 years.

RESULTS: Patients with bilateral internal thoracic artery grafting were younger, were mostly male, and had less diabetes, hypertension, unstable angina, and recent myocardial infarction than patients undergoing single internal thoracic artery grafting. Thirty-day mortality was 2.3% for the group undergoing single internal thoracic artery grafting versus 1.2% for those undergoing bilateral internal thoracic artery grafting (P = .007). Survival probability at 10 years was 88% for the single-graft group compared with 93% for the bilateral-graft group (P < .001). Multivariate analysis with propensity scoring showed that bilateral internal thoracic artery grafting decreased the risk of death (hazard ratio, 0.74; 95% confidence interval, 0.60-0.90), myocardial infarction (hazard ratio, 0.79; 95% confidence interval, 0.67-0.93), and coronary reoperation (hazard ratio, 0.41; 95% confidence interval, 0.21-0.80) throughout the follow-up period. Other significant predictors of death were diabetes, prior myocardial infarction, need for intra-aortic balloon pump, chronic heart failure, and peripheral vascular disease.

CONCLUSION: Patients undergoing bilateral internal thoracic plus saphenous vein grafting appear to have a significantly better long-term clinical outcome than patients undergoing single internal thoracic artery plus saphenous vein grafting for multivessel coronary artery bypass grafting.




This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
C. Y. Kim, H. Y. Hwang, J. C. Paeng, D. S. Lee, and K.-B. Kim
Improved myocardial perfusion and thickening after off-pump revascularization: 5-year follow-up.
Ann. Thorac. Surg., November 1, 2009; 88(5): 1419 - 1425.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
M. Tabata, J. D. Grab, Z. Khalpey, F. H. Edwards, S. M. O'Brien, L. H. Cohn, and R. M. Bolman III
Prevalence and Variability of Internal Mammary Artery Graft Use in Contemporary Multivessel Coronary Artery Bypass Graft Surgery: Analysis of the Society of Thoracic Surgeons National Cardiac Database
Circulation, September 15, 2009; 120(11): 935 - 940.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
D. Navia, M. Vrancic, G. Vaccarino, F. Piccinini, H. Raich, S. Florit, and J. Thierer
Total Arterial Off-Pump Coronary Revascularization Using Bilateral Internal Thoracic Arteries in Triple-Vessel Disease: Surgical Technique and Clinical Outcomes
Ann. Thorac. Surg., August 1, 2008; 86(2): 524 - 530.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
S. Mohammadi, F. Dagenais, D. Doyle, P. Mathieu, R. Baillot, E. Charbonneau, J. Perron, and P. Voisine
Age cut-off for the loss of benefit from bilateral internal thoracic artery grafting
Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 977 - 982.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J.F. M. Bechtel, C. Detter, T. Fischlein, T. Krabatsch, B. R. Osswald, F.-C. Riess, F. Scholz, M. Schonburg, C. Stamm, H.-H. Sievers, et al.
Cardiac Surgery in Patients on Dialysis: Decreased 30-Day Mortality, Unchanged Overall Survival
Ann. Thorac. Surg., January 1, 2008; 85(1): 147 - 153.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Kai, M. Hanyu, Y. Soga, T. Nomoto, J. Nakano, T. Matsuo, E. Umehara, M. Kawato, and H. Okabayashi
Off-Pump Coronary Artery Bypass Grafting With Skeletonized Bilateral Internal Thoracic Arteries in Insulin-Dependent Diabetics
Ann. Thorac. Surg., July 1, 2007; 84(1): 32 - 36.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Kai, H. Okabayashi, M. Hanyu, Y. Soga, T. Nomoto, J. Nakano, T. Matsuo, E. Umehara, and M. Kawato
Long-Term Results of Bilateral Internal Thoracic Artery Grafting in Dialysis Patients
Ann. Thorac. Surg., May 1, 2007; 83(5): 1666 - 1671.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
C. Berroeta, A. Benbara, S. Provenchere, N. Ajzenberg, J. Benessiano, J.-P. Depoix, J.-M. Desmonts, B. Iung, and I. Philip
A Comparison of Bilateral with Single Internal Mammary Artery Grafts on Postoperative Mediastinal Drainage and Transfusion Requirement
Anesth. Analg., December 1, 2006; 103(6): 1380 - 1385.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
F. Formica, O. Ferro, M. Brustia, F. Corti, L. Colagrande, E. Bosisio, and G. Paolini
Effects of Papaverine and Glycerilnitrate-Verapamil Solution as Topical and Intraluminal Vasodilators for Internal Thoracic Artery
Ann. Thorac. Surg., January 1, 2006; 81(1): 120 - 124.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. Zeitani, A. P. de Peppo, R. De Paulis, P. Nardi, A. Scafuri, S. Nardella, and L. Chiariello
Benefit of Partial Right-Bilateral Internal Thoracic Artery Harvesting in Patients at Risk of Sternal Wound Complications
Ann. Thorac. Surg., January 1, 2006; 81(1): 139 - 143.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Carrier
Invited commentary
Ann. Thorac. Surg., January 1, 2006; 81(1): 144 - 144.
[Full Text] [PDF]

Home page
 CirculationHome page
H. Nishida, Y. Tomizawa, M. Endo, and H. Kurosawa
Survival Benefit of Exclusive Use of In Situ Arterial Conduits Over Combined Use of Arterial and Vein Grafts for Multiple Coronary Artery Bypass Grafting
Circulation, August 30, 2005; 112(9_suppl): I-299 - I-303.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
O. A. Khan, R. Chau, C. Bertram, M. A. Hanson, and S. K. Ohri
Fetal origins of coronary heart disease--implications for cardiothoracic surgery?
Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 1036 - 1042.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. De Paulis, S. de Notaris, R. Scaffa, S. Nardella, J. Zeitani, C. Del Giudice, A. Penta De Peppo, F. Tomai, and L. Chiariello
The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: The role of skeletonization
J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 536 - 543.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
L.M. Stevens, M. Carrier, L.P. Perrault, Y. Hebert, R. Cartier, D. Bouchard, A. Fortier, and M. Pellerin
Influence of diabetes and bilateral internal thoracic artery grafts on long-term outcome for multivessel coronary artery bypass grafting
Eur. J. Cardiothorac. Surg., February 1, 2005; 27(2): 281 - 288.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
F. Formica, O. Ferro, P. Greco, A. Martino, D. Gastaldi, and G. Paolini
Long-term follow-up of total arterial myocardial revascularization using exclusively pedicle bilateral internal thoracic artery and right gastroepiploic artery
Eur. J. Cardiothorac. Surg., December 1, 2004; 26(6): 1141 - 1148.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2004 by The American Association for Thoracic Surgery.