The Thoracic and cardiovascular surgeon · 2022
Bypass Grafting to Circumflex: Left Internal Thoracic Artery versus Saphenous Vein.
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Uchino Gaku, Murakami Hirohisa, Mukohara Nobuhiko, Tanaka Hiroshi, Nomura Yoshikatsu, Miyahara Shunsuke
Аннотация
BACKGROUND: This study aimed to compare the short- and long-term outcomes of saphenous vein grafts (SVGs) and in situ left internal thoracic artery (LITA) grafts to the left circumflex artery (LCX) territory.
METHODS: This study included 678 patients who underwent LITA-left anterior descending (LAD) + SVG-LCX grafts and 286 patients who underwent right internal thoracic artery (RITA)-LAD + in situ LITA-LCX grafts from January 2002 to December 2020. Short-term and long-term clinical outcomes were compared using inverse probability of treatment weighting adjustment to reduce selection bias.
RESULTS: In-hospital mortality was significantly higher for the SVG-LCX group (p = 0.008), whereas deep sternal wound infection was significantly higher in the LITA-LCX group (p = 0.013).Survival rates at 5 and 10 years were 83.12 and 71.45% in the SVG-LCX group, whereas 75.24 and 65.54% in the LITA-LCX group (log-rank p = 0.114). Rates of freedom from cardiac events at 5 and 10 years were 92.82 and 85.24% in the SVG-LCX group, whereas 94.89 and 89.46% in the LITA-LCX group (log-rank p = 0.179).Univariate and multivariate logistic regression analysis showed that proximal severe stenosis was significantly protective against graft dysfunction before discharge (odds ratio, 0.43; 95% confidence interval, 0.23-0.81).
CONCLUSION: Deep sternal wound infection was significantly higher for LITA to LCX bypass whereas in-hospital mortality was higher for SVG to LCX. In situ LITA to LCX bypass grafting exhibited similar long-term outcomes with SVG to LCX bypass grafting in adjusted patient cohorts. Proximal severe stenosis of LCX was protective against graft dysfunction.
METHODS: This study included 678 patients who underwent LITA-left anterior descending (LAD) + SVG-LCX grafts and 286 patients who underwent right internal thoracic artery (RITA)-LAD + in situ LITA-LCX grafts from January 2002 to December 2020. Short-term and long-term clinical outcomes were compared using inverse probability of treatment weighting adjustment to reduce selection bias.
RESULTS: In-hospital mortality was significantly higher for the SVG-LCX group (p = 0.008), whereas deep sternal wound infection was significantly higher in the LITA-LCX group (p = 0.013).Survival rates at 5 and 10 years were 83.12 and 71.45% in the SVG-LCX group, whereas 75.24 and 65.54% in the LITA-LCX group (log-rank p = 0.114). Rates of freedom from cardiac events at 5 and 10 years were 92.82 and 85.24% in the SVG-LCX group, whereas 94.89 and 89.46% in the LITA-LCX group (log-rank p = 0.179).Univariate and multivariate logistic regression analysis showed that proximal severe stenosis was significantly protective against graft dysfunction before discharge (odds ratio, 0.43; 95% confidence interval, 0.23-0.81).
CONCLUSION: Deep sternal wound infection was significantly higher for LITA to LCX bypass whereas in-hospital mortality was higher for SVG to LCX. In situ LITA to LCX bypass grafting exhibited similar long-term outcomes with SVG to LCX bypass grafting in adjusted patient cohorts. Proximal severe stenosis of LCX was protective against graft dysfunction.