BACKGROUND: To minimize aortic manipulation and maximize use of arterial conduits are aims of modern coronary surgery. METHODS: From March 2012 to October 2016, 890 consecutive patients with multivessel coronary disease underwent isolated coronary surgery using both internal thoracic arteries (ITAs). In 205 (23%; mean age, 67.6±9.2 years), the right ITA was proximally transected and used as free graft, while its in situ stump was elongated with a saphenous vein graft. The new arteriovenous I-conduit was directed to the inferolateral cardiac wall. Operative data and early outcomes of these patients (I-group) were compared with the remaining 685 patients (C-group). Early and late outcomes were compared also in 184 pairs identified with the propensity score-matching. RESULTS: Between I and C-group there was no significant difference on expected operative risk (European System for Cardiac Operative Risk Evaluation II, p=0.28), though diseased ascending aorta (p<0.0001) and critical preoperative state (p=0.027) were more frequent in I-group. Despite higher number of coronary anastomoses (mean, 4±0.9 vs. 3.7±1, p<0.0001), cardiopulmonary bypass time (minutes) was shorter in I-group both in overall (86.7±23.7 vs. 105.7±34.2, p<0.0001) and matched series (86.8±24.1 vs. 108.8±31.9, p<0.0001). In-hospital mortality (1% vs. 1.9%, p=0.54) and the rates of postoperative complications were similar. During the follow-up period, in matched patients, no intergroup difference was found about the non-parametric estimates of freedom from all-cause death (p=0.39) and major adverse cardiac and cerebrovascular events (p=0.44). CONCLUSIONS: Surgery using this arteriovenous I-conduit is safe, minimizes aortic manipulation, makes shorter cardiopulmonary bypass time, and aids complete revascularization.

Clinical validation of a coronary surgery technique that minimizes aortic manipulation

Gatti, Giuseppe;Biondi, Federico;Porcari, Aldostefano;Belgrano, Manuel;Sinagra, Gianfranco;
2019

Abstract

BACKGROUND: To minimize aortic manipulation and maximize use of arterial conduits are aims of modern coronary surgery. METHODS: From March 2012 to October 2016, 890 consecutive patients with multivessel coronary disease underwent isolated coronary surgery using both internal thoracic arteries (ITAs). In 205 (23%; mean age, 67.6±9.2 years), the right ITA was proximally transected and used as free graft, while its in situ stump was elongated with a saphenous vein graft. The new arteriovenous I-conduit was directed to the inferolateral cardiac wall. Operative data and early outcomes of these patients (I-group) were compared with the remaining 685 patients (C-group). Early and late outcomes were compared also in 184 pairs identified with the propensity score-matching. RESULTS: Between I and C-group there was no significant difference on expected operative risk (European System for Cardiac Operative Risk Evaluation II, p=0.28), though diseased ascending aorta (p<0.0001) and critical preoperative state (p=0.027) were more frequent in I-group. Despite higher number of coronary anastomoses (mean, 4±0.9 vs. 3.7±1, p<0.0001), cardiopulmonary bypass time (minutes) was shorter in I-group both in overall (86.7±23.7 vs. 105.7±34.2, p<0.0001) and matched series (86.8±24.1 vs. 108.8±31.9, p<0.0001). In-hospital mortality (1% vs. 1.9%, p=0.54) and the rates of postoperative complications were similar. During the follow-up period, in matched patients, no intergroup difference was found about the non-parametric estimates of freedom from all-cause death (p=0.39) and major adverse cardiac and cerebrovascular events (p=0.44). CONCLUSIONS: Surgery using this arteriovenous I-conduit is safe, minimizes aortic manipulation, makes shorter cardiopulmonary bypass time, and aids complete revascularization.
13-nov-2018
Pubblicato
https://www.sciencedirect.com/science/article/pii/S0003497518316412?via%3Dihub#appsec1
File in questo prodotto:
File Dimensione Formato  
1-s2.0-S0003497518316412-main.pdf

non disponibili

Tipologia: Documento in Versione Editoriale
Licenza: Copyright Editore
Dimensione 598.86 kB
Formato Adobe PDF
598.86 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Supplementary data.pdf

non disponibili

Descrizione: Supplementary data
Tipologia: Altro materiale allegato
Licenza: Digital Rights Management non definito
Dimensione 164.65 kB
Formato Adobe PDF
164.65 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Supplementary text.pdf

non disponibili

Descrizione: Supplementary text
Tipologia: Altro materiale allegato
Licenza: Digital Rights Management non definito
Dimensione 295.07 kB
Formato Adobe PDF
295.07 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
2935660_1-s2.0-S0003497518316412-main-PostPrint.pdf

accesso aperto

Descrizione: Post Print VQR3
Tipologia: Bozza finale post-referaggio (post-print)
Licenza: Digital Rights Management non definito
Dimensione 1.13 MB
Formato Adobe PDF
1.13 MB Adobe PDF Visualizza/Apri
2935660_Supplementary data-PostPrint.pdf

accesso aperto

Descrizione: Post Print VQR3
Tipologia: Bozza finale post-referaggio (post-print)
Licenza: Digital Rights Management non definito
Dimensione 737.14 kB
Formato Adobe PDF
737.14 kB Adobe PDF Visualizza/Apri
2935660_Supplementary text-PostPrint.pdf

accesso aperto

Descrizione: Post Print VQR3
Tipologia: Bozza finale post-referaggio (post-print)
Licenza: Digital Rights Management non definito
Dimensione 300.49 kB
Formato Adobe PDF
300.49 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11368/2935660
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 4
  • ???jsp.display-item.citation.isi??? 4
social impact