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Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly

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Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly. / Rubino, Antonino S; Gatti, Giuseppe; Reichart, Daniel; Tauriainen, Tuomas; De Feo, Marisa; Onorati, Francesco; Pappalardo, Aniello; Chocron, Sidney; Gulbins, Helmut; Dalén, Magnus; Svenarud, Peter; Faggian, Giuseppe; Franzese, Ilaria; Santarpino, Giuseppe; Fischlein, Theodor; Maselli, Daniele; Nardella, Saverio; Gherli, Riccardo; Ahmed, Aamer; Santini, Francesco; Salsano, Antonio; Nicolini, Francesco; Zanobini, Marco; Saccocci, Matteo; Ruggieri, Vito G; Bounader, Karl; Mignosa, Carmelo; D'Errigo, Paola; Rosato, Stefano; Airaksinen, Juhani; Perrotti, Andrea; Biancari, Fausto.

In: ANN THORAC SURG, Vol. 105, No. 6, 06.2018, p. 1717-1723.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Rubino, AS, Gatti, G, Reichart, D, Tauriainen, T, De Feo, M, Onorati, F, Pappalardo, A, Chocron, S, Gulbins, H, Dalén, M, Svenarud, P, Faggian, G, Franzese, I, Santarpino, G, Fischlein, T, Maselli, D, Nardella, S, Gherli, R, Ahmed, A, Santini, F, Salsano, A, Nicolini, F, Zanobini, M, Saccocci, M, Ruggieri, VG, Bounader, K, Mignosa, C, D'Errigo, P, Rosato, S, Airaksinen, J, Perrotti, A & Biancari, F 2018, 'Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly', ANN THORAC SURG, vol. 105, no. 6, pp. 1717-1723. https://doi.org/10.1016/j.athoracsur.2017.11.079

APA

Rubino, A. S., Gatti, G., Reichart, D., Tauriainen, T., De Feo, M., Onorati, F., Pappalardo, A., Chocron, S., Gulbins, H., Dalén, M., Svenarud, P., Faggian, G., Franzese, I., Santarpino, G., Fischlein, T., Maselli, D., Nardella, S., Gherli, R., Ahmed, A., ... Biancari, F. (2018). Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly. ANN THORAC SURG, 105(6), 1717-1723. https://doi.org/10.1016/j.athoracsur.2017.11.079

Vancouver

Rubino AS, Gatti G, Reichart D, Tauriainen T, De Feo M, Onorati F et al. Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly. ANN THORAC SURG. 2018 Jun;105(6):1717-1723. https://doi.org/10.1016/j.athoracsur.2017.11.079

Bibtex

@article{1fea738bde3340bd9cc68da6d4346307,
title = "Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly",
abstract = "BACKGROUND: Bilateral internal mammary artery (BIMA) grafting is increasingly used in elderly patients without evidence of its risks or benefits compared with single internal mammary artery (SIMA) grafting.METHODS: In all, 2,899 patients aged 70 years or older (855 [29.5%] underwent BIMA grafting) operated on from January 2015 to December 2016 and included in the prospective multicenter Outcome After Coronary Artery Bypass Grafting (E-CABG) study were considered in this analysis.RESULTS: One-to-one propensity matching resulted in 804 pairs with similar preoperative risk profile. Propensity score matched analysis showed that BIMA grafting was associated with a nonstatistically significant increased risk of inhospital death (2.7% versus 1.6%, p = 0.117). The BIMA grafting cohort had a significantly increased risk of any sternal wound infection (7.7% versus 5.1%, p = 0.031) as well as higher risk of deep sternal wound infection/mediastinitis (4.0% versus 2.2%, p = 0.048). The BIMA grafting cohort required more frequently extracorporeal membrane oxygenation (1.0% versus 0.1%, p = 0.02), and the intensive care unit stay (mean 3.6 versus 2.6 days, p < 0.001) and inhospital stay (mean 11.3 versus 10.0 days, p < 0.001) were significantly longer compared with the SIMA grafting cohort. Test for interaction showed that urgent operation in patients undergoing BIMA grafting was associated with higher risk of inhospital death (5.6% versus 1.3%, p = 0.009).CONCLUSIONS: Bilateral internal mammary artery grafting in elderly patients seems to be associated with a worse early outcome compared with SIMA grafting, particularly in patients undergoing urgent operation. Until more conclusive results are gathered, BIMA grafting should be reserved only for elderly patients with stable coronary artery disease, without significant baseline comorbidities and with long life expectancy.",
keywords = "Age Factors, Aged, Aged, 80 and over, Cohort Studies, Confidence Intervals, Coronary Artery Bypass/adverse effects, Coronary Artery Disease/diagnostic imaging, Female, Geriatric Assessment, Hospital Mortality/trends, Humans, Internal Mammary-Coronary Artery Anastomosis/adverse effects, Male, Mammary Arteries/transplantation, Odds Ratio, Postoperative Complications/epidemiology, Prognosis, Propensity Score, Prospective Studies, Risk Assessment, Survival Rate, Treatment Outcome",
author = "Rubino, {Antonino S} and Giuseppe Gatti and Daniel Reichart and Tuomas Tauriainen and {De Feo}, Marisa and Francesco Onorati and Aniello Pappalardo and Sidney Chocron and Helmut Gulbins and Magnus Dal{\'e}n and Peter Svenarud and Giuseppe Faggian and Ilaria Franzese and Giuseppe Santarpino and Theodor Fischlein and Daniele Maselli and Saverio Nardella and Riccardo Gherli and Aamer Ahmed and Francesco Santini and Antonio Salsano and Francesco Nicolini and Marco Zanobini and Matteo Saccocci and Ruggieri, {Vito G} and Karl Bounader and Carmelo Mignosa and Paola D'Errigo and Stefano Rosato and Juhani Airaksinen and Andrea Perrotti and Fausto Biancari",
note = "Copyright {\textcopyright} 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.",
year = "2018",
month = jun,
doi = "10.1016/j.athoracsur.2017.11.079",
language = "English",
volume = "105",
pages = "1717--1723",
journal = "ANN THORAC SURG",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "6",

}

RIS

TY - JOUR

T1 - Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly

AU - Rubino, Antonino S

AU - Gatti, Giuseppe

AU - Reichart, Daniel

AU - Tauriainen, Tuomas

AU - De Feo, Marisa

AU - Onorati, Francesco

AU - Pappalardo, Aniello

AU - Chocron, Sidney

AU - Gulbins, Helmut

AU - Dalén, Magnus

AU - Svenarud, Peter

AU - Faggian, Giuseppe

AU - Franzese, Ilaria

AU - Santarpino, Giuseppe

AU - Fischlein, Theodor

AU - Maselli, Daniele

AU - Nardella, Saverio

AU - Gherli, Riccardo

AU - Ahmed, Aamer

AU - Santini, Francesco

AU - Salsano, Antonio

AU - Nicolini, Francesco

AU - Zanobini, Marco

AU - Saccocci, Matteo

AU - Ruggieri, Vito G

AU - Bounader, Karl

AU - Mignosa, Carmelo

AU - D'Errigo, Paola

AU - Rosato, Stefano

AU - Airaksinen, Juhani

AU - Perrotti, Andrea

AU - Biancari, Fausto

N1 - Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

PY - 2018/6

Y1 - 2018/6

N2 - BACKGROUND: Bilateral internal mammary artery (BIMA) grafting is increasingly used in elderly patients without evidence of its risks or benefits compared with single internal mammary artery (SIMA) grafting.METHODS: In all, 2,899 patients aged 70 years or older (855 [29.5%] underwent BIMA grafting) operated on from January 2015 to December 2016 and included in the prospective multicenter Outcome After Coronary Artery Bypass Grafting (E-CABG) study were considered in this analysis.RESULTS: One-to-one propensity matching resulted in 804 pairs with similar preoperative risk profile. Propensity score matched analysis showed that BIMA grafting was associated with a nonstatistically significant increased risk of inhospital death (2.7% versus 1.6%, p = 0.117). The BIMA grafting cohort had a significantly increased risk of any sternal wound infection (7.7% versus 5.1%, p = 0.031) as well as higher risk of deep sternal wound infection/mediastinitis (4.0% versus 2.2%, p = 0.048). The BIMA grafting cohort required more frequently extracorporeal membrane oxygenation (1.0% versus 0.1%, p = 0.02), and the intensive care unit stay (mean 3.6 versus 2.6 days, p < 0.001) and inhospital stay (mean 11.3 versus 10.0 days, p < 0.001) were significantly longer compared with the SIMA grafting cohort. Test for interaction showed that urgent operation in patients undergoing BIMA grafting was associated with higher risk of inhospital death (5.6% versus 1.3%, p = 0.009).CONCLUSIONS: Bilateral internal mammary artery grafting in elderly patients seems to be associated with a worse early outcome compared with SIMA grafting, particularly in patients undergoing urgent operation. Until more conclusive results are gathered, BIMA grafting should be reserved only for elderly patients with stable coronary artery disease, without significant baseline comorbidities and with long life expectancy.

AB - BACKGROUND: Bilateral internal mammary artery (BIMA) grafting is increasingly used in elderly patients without evidence of its risks or benefits compared with single internal mammary artery (SIMA) grafting.METHODS: In all, 2,899 patients aged 70 years or older (855 [29.5%] underwent BIMA grafting) operated on from January 2015 to December 2016 and included in the prospective multicenter Outcome After Coronary Artery Bypass Grafting (E-CABG) study were considered in this analysis.RESULTS: One-to-one propensity matching resulted in 804 pairs with similar preoperative risk profile. Propensity score matched analysis showed that BIMA grafting was associated with a nonstatistically significant increased risk of inhospital death (2.7% versus 1.6%, p = 0.117). The BIMA grafting cohort had a significantly increased risk of any sternal wound infection (7.7% versus 5.1%, p = 0.031) as well as higher risk of deep sternal wound infection/mediastinitis (4.0% versus 2.2%, p = 0.048). The BIMA grafting cohort required more frequently extracorporeal membrane oxygenation (1.0% versus 0.1%, p = 0.02), and the intensive care unit stay (mean 3.6 versus 2.6 days, p < 0.001) and inhospital stay (mean 11.3 versus 10.0 days, p < 0.001) were significantly longer compared with the SIMA grafting cohort. Test for interaction showed that urgent operation in patients undergoing BIMA grafting was associated with higher risk of inhospital death (5.6% versus 1.3%, p = 0.009).CONCLUSIONS: Bilateral internal mammary artery grafting in elderly patients seems to be associated with a worse early outcome compared with SIMA grafting, particularly in patients undergoing urgent operation. Until more conclusive results are gathered, BIMA grafting should be reserved only for elderly patients with stable coronary artery disease, without significant baseline comorbidities and with long life expectancy.

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Cohort Studies

KW - Confidence Intervals

KW - Coronary Artery Bypass/adverse effects

KW - Coronary Artery Disease/diagnostic imaging

KW - Female

KW - Geriatric Assessment

KW - Hospital Mortality/trends

KW - Humans

KW - Internal Mammary-Coronary Artery Anastomosis/adverse effects

KW - Male

KW - Mammary Arteries/transplantation

KW - Odds Ratio

KW - Postoperative Complications/epidemiology

KW - Prognosis

KW - Propensity Score

KW - Prospective Studies

KW - Risk Assessment

KW - Survival Rate

KW - Treatment Outcome

U2 - 10.1016/j.athoracsur.2017.11.079

DO - 10.1016/j.athoracsur.2017.11.079

M3 - SCORING: Journal article

C2 - 29410264

VL - 105

SP - 1717

EP - 1723

JO - ANN THORAC SURG

JF - ANN THORAC SURG

SN - 0003-4975

IS - 6

ER -