Abstract
Background
Peripheral arterial disease (PAD) is known to have a poor prognosis. Some reports have also described poor late results after coronary artery bypass grafting (CABG). However, there have been few reports about whether bilateral internal thoracic artery grafting improves the long-term survival of PAD patients after CABG. We performed this study to clarify whether or not this is the case.
Methods
One hundred and thirty-six PAD patients who underwent elective CABG with two or more grafts were enrolled in this study. Patients were divided into two groups, 71 patients in the bilateral internal thoracic artery (BITA) group and 65 patients in the single internal thoracic artery (SITA) group. The maximum follow-up period was 19 years, with a mean of 5.7 ± 4.4 years.
Results
We investigated the long-term results based on three factors; survival, freedom from cardiac death, and freedom from cardiac events. The 3-, 5- and 10-year survival rates in the BITA group were 83.0, 74.2, and 43.1 %, respectively. And those in the SITA group were 79.4, 67.7, and 32.3 %, respectively. There were no significant differences between the two groups (p = 0.5843). There were also no statistically significant differences between the two groups in terms of the freedom from cardiac death (p = 0.8589) or in the freedom from cardiac events (p = 0.9445).
Conclusion
No long-term advantage was observed for CABG with BITA in comparison to SITA alone in patients with PAD.
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References
Sakata R, Kuwano H, Yokomise H. Hospital volume and outcomes of cardiothoracic surgery in Japan: 2005–2009 national survey. Gen Thorac Cardiovasc Surg. 2012;60:625–38.
Pande RL, Perlstein TS, Beckman JA, Creager MA. Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999–2004. Circulation. 2011;124:17–23.
Higggins TL, Estafanous FG, Loop FD, Beck GJ, Blum JM, Paranandi L. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score. JAMA. 1992;267:2344–8.
O’Connor GT, Plume SK, Olmsted EM, et al. Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery. Northern New England Cardiovascular Disease Study Group. Circulation. 1992;85:2210–8.
Chu D, Bakaeen FG, Wang XL, Dao TK, LeMaire SA, Coselli JS, Huh J. The impact of peripheral vascular disease on long-term survival after coronary artery bypass graft surgery. Ann Thorac Surg. 2008;86:1175–80.
van Straten AH, Firanescu C, Soliman Hamad MA, et al. Peripheral vascular disease as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population. Ann Thorac Surg. 2010;89:414–20.
Lytle BW, Blackstone EH, Loop FD, et al. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg. 1999;117:855–72.
Ura M, Sakata R, Nakayama Y, Arai Y, Saito T. Long-term results of bilateral internal thoracic artery grafting. Ann Thorac Surg. 2000;70:1991–6.
Pevni D, Uretzky G, Mohr A, et al. Routine use of bilateral skeletonized internal thoracic artery grafting: long-term results. Circulation. 2008;118:705–12.
Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularization on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet. 2001;358:870–5.
Nakatsu T, Tamura N, Sakakibara Y, Hagio K, Ishigami M. Long-term survival after coronary arterial grafts in patients with end-stage renal disease. Ann Thorac Surg. 2010;90:738–43.
Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASCII). J Vasc Surg. 2007;45(Suppl S):S5–67.
Fukui T, Tabata M, Matsuyama S, Takanashi S. Graft selection in elderly patients undergoing coronary artery bypass grafting. Gen Thorac Cardiovasc Surg. 2011;59:786–92.
Lytle BW, Blackstone EH, Sabik JF, Houqhtalinq P, Loop FD, Cosgrove DM. The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Ann Thorac Surg. 2004;78:2005–14.
Serruys BW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass for severe coronary artery disease. N Engl J Med. 2009;360(10):964–72.
Biancari F, Mosorin M, Rasinaho E, et al. Postoperative stroke after off-pump versus on-pump coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2007;133:169–73.
Li Z, Denton T, Yeo KK, et al. Off-pump bypass surgery and postoperative stroke: California coronary bypass outcomes reporting program. Ann Thorac Surg. 2010;90:753–9.
Banerjee A, Fowkes FG, Rothwell PM. Associations between peripheral artery disease and ischemic stroke: implications for primary and secondary prevention. Stroke. 2010;41:2102–7.
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Nakatsu, T., Tamura, N., Yanagi, S. et al. Bilateral internal thoracic artery grafting for peripheral arterial disease patients. Gen Thorac Cardiovasc Surg 62, 481–487 (2014). https://doi.org/10.1007/s11748-014-0371-4
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DOI: https://doi.org/10.1007/s11748-014-0371-4