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Left internal thoracic artery-radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: a prospective randomized evaluation.
J Thorac Cardiovasc Surg. 2004 Jan; 127(1):179-84.JT

Abstract

OBJECTIVES

The technique of choice for myocardial revascularization in elderly patients remains a debated issue. We evaluated the potential advantages of the use of left internal thoracic artery-radial artery composite grafts compared with conventional coronary artery bypass grafts in elderly patients.

METHODS

We prospectively enrolled 160 patients aged more than 70 years scheduled to undergo isolated myocardial revascularization. Patients were assigned at random to group 1, 80 patients undergoing total arterial revascularization (left internal thoracic artery on left anterior descending coronary artery plus radial artery), or group 2, 80 patients undergoing standard coronary artery bypass graft surgery (left internal thoracic artery on left anterior descending coronary artery plus saphenous veins). The radial artery was used in all cases as a composite Y-graft.

RESULTS

Preoperative characteristics and risk factors (EuroSCORE: group 1 = 7.9 vs group 2 = 8.1), number of grafted coronary vessels (group 1 = 2.4 vs group 2 = 2.5), aortic crossclamping time (group 1 = 37 +/- 7 minutes vs group 2 = 38 +/- 7 minutes), ventilation time (group 1 = 22 +/- 12 hours vs group 2 = 23 +/- 11 hours), intensive care unit stay (group 1 = 39 +/- 10 hours vs group 2 = 40 +/- 9 hours), and hospital mortality (group 1 = 3.8% vs group 2 = 5%) were comparable between the groups. Comparison between the 2 groups in terms of early postoperative complications showed a higher incidence of cerebrovascular accidents in group 2 (group 1 = 0 patients vs group 2 = 4 patients, 5%). At a mean follow-up of 16 +/- 3 months, patients in group 1 showed superior clinical results with a lower incidence of graft occlusion (group 1 = 2 vs group 2 = 11; P =.06) and angina recurrence (group 1 = 2 patients vs group 2 = 12 patients; P =.03). Multivariate analysis identified saphenous vein grafts as independent predictors for graft occlusion and angina recurrence.

CONCLUSIONS

Left internal thoracic artery-radial artery composite grafts proved to be a safe procedure in elderly patients. It improved the clinical outcome, providing a significantly higher graft patency rate and a lower incidence of late cardiac events.

Authors+Show Affiliations

Division of Cardiac Surgery, University of Brescia Medical School, Italy. munerett@master.cci.unibs.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

14752429

Citation

Muneretto, Claudio, et al. "Left Internal Thoracic Artery-radial Artery Composite Grafts as the Technique of Choice for Myocardial Revascularization in Elderly Patients: a Prospective Randomized Evaluation." The Journal of Thoracic and Cardiovascular Surgery, vol. 127, no. 1, 2004, pp. 179-84.
Muneretto C, Bisleri G, Negri A, et al. Left internal thoracic artery-radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: a prospective randomized evaluation. J Thorac Cardiovasc Surg. 2004;127(1):179-84.
Muneretto, C., Bisleri, G., Negri, A., Manfredi, J., Carone, E., Morgan, J. A., Metra, M., & Dei Cas, L. (2004). Left internal thoracic artery-radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: a prospective randomized evaluation. The Journal of Thoracic and Cardiovascular Surgery, 127(1), 179-84.
Muneretto C, et al. Left Internal Thoracic Artery-radial Artery Composite Grafts as the Technique of Choice for Myocardial Revascularization in Elderly Patients: a Prospective Randomized Evaluation. J Thorac Cardiovasc Surg. 2004;127(1):179-84. PubMed PMID: 14752429.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Left internal thoracic artery-radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: a prospective randomized evaluation. AU - Muneretto,Claudio, AU - Bisleri,Gianluigi, AU - Negri,Alberto, AU - Manfredi,Jacopo, AU - Carone,Enrico, AU - Morgan,Jeffrey A, AU - Metra,Marco, AU - Dei Cas,Livio, PY - 2004/1/31/pubmed PY - 2004/3/5/medline PY - 2004/1/31/entrez SP - 179 EP - 84 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 127 IS - 1 N2 - OBJECTIVES: The technique of choice for myocardial revascularization in elderly patients remains a debated issue. We evaluated the potential advantages of the use of left internal thoracic artery-radial artery composite grafts compared with conventional coronary artery bypass grafts in elderly patients. METHODS: We prospectively enrolled 160 patients aged more than 70 years scheduled to undergo isolated myocardial revascularization. Patients were assigned at random to group 1, 80 patients undergoing total arterial revascularization (left internal thoracic artery on left anterior descending coronary artery plus radial artery), or group 2, 80 patients undergoing standard coronary artery bypass graft surgery (left internal thoracic artery on left anterior descending coronary artery plus saphenous veins). The radial artery was used in all cases as a composite Y-graft. RESULTS: Preoperative characteristics and risk factors (EuroSCORE: group 1 = 7.9 vs group 2 = 8.1), number of grafted coronary vessels (group 1 = 2.4 vs group 2 = 2.5), aortic crossclamping time (group 1 = 37 +/- 7 minutes vs group 2 = 38 +/- 7 minutes), ventilation time (group 1 = 22 +/- 12 hours vs group 2 = 23 +/- 11 hours), intensive care unit stay (group 1 = 39 +/- 10 hours vs group 2 = 40 +/- 9 hours), and hospital mortality (group 1 = 3.8% vs group 2 = 5%) were comparable between the groups. Comparison between the 2 groups in terms of early postoperative complications showed a higher incidence of cerebrovascular accidents in group 2 (group 1 = 0 patients vs group 2 = 4 patients, 5%). At a mean follow-up of 16 +/- 3 months, patients in group 1 showed superior clinical results with a lower incidence of graft occlusion (group 1 = 2 vs group 2 = 11; P =.06) and angina recurrence (group 1 = 2 patients vs group 2 = 12 patients; P =.03). Multivariate analysis identified saphenous vein grafts as independent predictors for graft occlusion and angina recurrence. CONCLUSIONS: Left internal thoracic artery-radial artery composite grafts proved to be a safe procedure in elderly patients. It improved the clinical outcome, providing a significantly higher graft patency rate and a lower incidence of late cardiac events. SN - 0022-5223 UR - https://www.unboundmedicine.com/medline/citation/14752429/Left_internal_thoracic_artery_radial_artery_composite_grafts_as_the_technique_of_choice_for_myocardial_revascularization_in_elderly_patients:_a_prospective_randomized_evaluation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022522303014429 DB - PRIME DP - Unbound Medicine ER -