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Long-term follow-up of coronary artery bypass grafting in three-vessel disease using exclusively pedicled bilateral internal thoracic and right gastroepiploic arteries.
Ann Thorac Surg. 2004 Mar; 77(3):794-9; discussion 799.AT

Abstract

BACKGROUND

Considerable data now exist that show that coronary artery bypass grafting with bilateral internal thoracic artery (ITA) grafts produce better outcomes than the use of a single ITA graft. The benefit of a third arterial graft has been less well established. Therefore this article describes the survival and cardiac-related event-free survival in patients having bilateral ITA and gastroepiploic artery (GEA) grafting for 3-vessel disease.

METHODS

From November 1992 to May 2002, 201 patients (mean age 53 +/- 7 years) presented with 3-vessel disease and received exclusively bilateral internal thoracic (ITAs) and right gastroepiploic (GEA) arteries as pedicled grafts for coronary artery bypass procedure. Twenty-seven (13%) patients were not elective, 10 (5%) were reoperations, 115 (57%) had one or more myocardial infarction, 21 (10%) had diabetes. In total 733 anastomoses were constructed (3.7/patient), with sequential grafting in 124 (62%) patients. The clinical follow-up was complete. The patients were followed for up to 10 years (mean 6.4 +/- 2.7 years).

RESULTS

Ten-year actuarial survival (including in-hospital death) was 87%. The actuarial freedom from angina pectoris, after hospital discharge, was 97% and 86% at 5 and 10 years respectively. None of the patients needed a repeat surgical revascularization after leaving the hospital, whereas 9 (5%) patients underwent a percutaneous transluminal coronary angioplasty. At 5 years 86% and at 10 years 69% of the patients remained free of any cardiac-related event.

CONCLUSIONS

The results of this study clearly indicate that the exclusive and extensive use of pedicled bilateral ITA and GEA in coronary bypass grafting provides excellent 10-year patient survival and functional improvement in terms of freedom from return of angina pectoris and, more impressive, freedom from any cardiac-related event. Our findings clearly corroborate the concomitant use of bilateral ITA and GEA grafts in selected patients with 3-vessel disease.

Authors+Show Affiliations

Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. gtavilla@lumc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14992873

Citation

Tavilla, Giuseppe, et al. "Long-term Follow-up of Coronary Artery Bypass Grafting in Three-vessel Disease Using Exclusively Pedicled Bilateral Internal Thoracic and Right Gastroepiploic Arteries." The Annals of Thoracic Surgery, vol. 77, no. 3, 2004, pp. 794-9; discussion 799.
Tavilla G, Kappetein AP, Braun J, et al. Long-term follow-up of coronary artery bypass grafting in three-vessel disease using exclusively pedicled bilateral internal thoracic and right gastroepiploic arteries. Ann Thorac Surg. 2004;77(3):794-9; discussion 799.
Tavilla, G., Kappetein, A. P., Braun, J., Gopie, J., Tjien, A. T., & Dion, R. A. (2004). Long-term follow-up of coronary artery bypass grafting in three-vessel disease using exclusively pedicled bilateral internal thoracic and right gastroepiploic arteries. The Annals of Thoracic Surgery, 77(3), 794-9; discussion 799.
Tavilla G, et al. Long-term Follow-up of Coronary Artery Bypass Grafting in Three-vessel Disease Using Exclusively Pedicled Bilateral Internal Thoracic and Right Gastroepiploic Arteries. Ann Thorac Surg. 2004;77(3):794-9; discussion 799. PubMed PMID: 14992873.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term follow-up of coronary artery bypass grafting in three-vessel disease using exclusively pedicled bilateral internal thoracic and right gastroepiploic arteries. AU - Tavilla,Giuseppe, AU - Kappetein,Arie Pieter, AU - Braun,Jerry, AU - Gopie,Jiwan, AU - Tjien,Andrew Tjon Joek, AU - Dion,Robert A E, PY - 2003/08/13/accepted PY - 2004/3/3/pubmed PY - 2004/4/9/medline PY - 2004/3/3/entrez SP - 794-9; discussion 799 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 77 IS - 3 N2 - BACKGROUND: Considerable data now exist that show that coronary artery bypass grafting with bilateral internal thoracic artery (ITA) grafts produce better outcomes than the use of a single ITA graft. The benefit of a third arterial graft has been less well established. Therefore this article describes the survival and cardiac-related event-free survival in patients having bilateral ITA and gastroepiploic artery (GEA) grafting for 3-vessel disease. METHODS: From November 1992 to May 2002, 201 patients (mean age 53 +/- 7 years) presented with 3-vessel disease and received exclusively bilateral internal thoracic (ITAs) and right gastroepiploic (GEA) arteries as pedicled grafts for coronary artery bypass procedure. Twenty-seven (13%) patients were not elective, 10 (5%) were reoperations, 115 (57%) had one or more myocardial infarction, 21 (10%) had diabetes. In total 733 anastomoses were constructed (3.7/patient), with sequential grafting in 124 (62%) patients. The clinical follow-up was complete. The patients were followed for up to 10 years (mean 6.4 +/- 2.7 years). RESULTS: Ten-year actuarial survival (including in-hospital death) was 87%. The actuarial freedom from angina pectoris, after hospital discharge, was 97% and 86% at 5 and 10 years respectively. None of the patients needed a repeat surgical revascularization after leaving the hospital, whereas 9 (5%) patients underwent a percutaneous transluminal coronary angioplasty. At 5 years 86% and at 10 years 69% of the patients remained free of any cardiac-related event. CONCLUSIONS: The results of this study clearly indicate that the exclusive and extensive use of pedicled bilateral ITA and GEA in coronary bypass grafting provides excellent 10-year patient survival and functional improvement in terms of freedom from return of angina pectoris and, more impressive, freedom from any cardiac-related event. Our findings clearly corroborate the concomitant use of bilateral ITA and GEA grafts in selected patients with 3-vessel disease. SN - 0003-4975 UR - https://www.unboundmedicine.com/medline/citation/14992873/Long_term_follow_up_of_coronary_artery_bypass_grafting_in_three_vessel_disease_using_exclusively_pedicled_bilateral_internal_thoracic_and_right_gastroepiploic_arteries_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S000349750301659X DB - PRIME DP - Unbound Medicine ER -