Department of cardiovascular surgery Kumamoto Central Hospital Taro Nakatsu, Nobushige Tamura, Takuya Nomoto, Koji Hagio, Masanosuke Ishigami, Shouichi.

Slides:

Advertisements

Similar presentations

Off pump CABG has been performed for the first time 40 years ago. Although conventional CABG is considered both safe and effective, the use of CBP.

Advertisements

MAIN-COMPARE Study Stents versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease.

Impact of Preoperative Renal Dysfunction in Patients Undergoing Off- pump vs On-pump Coronary Artery Bypass.

Total coronary revascularization with the internal thoracic arteries T graft B. El Nakadi, Y. De Bruyne, M. Joris C.H.U. de Charleroi, Belgium.

K Fox, W Remme, C Daly, M Bertrand, R Ferrari, M Simoons On behalf of the EUROPA investigators. The diabetic sub study of.

A few basics of cardiac surgery…. Brett Sheridan, MD Assistant Professor Department of Surgery.

Stages of CKD – KDOQI 2002 Definitions

CABG GUIDELINES SANJAY DRAVID, M.D.. INTRODUCTION ACC/AHA GUIDELINE UPDATE FOR CORONARY ARTERY BYPASS GRAFT SURGERY (JACC 2004; 44: AND CIRCULATION.

Open Repair of Ruptured Descending Thoracic and Thoracoabdominal Aortic Aneurysms in 100 Consecutive Cases Mario F. Gaudino, Christopher Lau, Monica Munjal,

Simultaneous Coronary Artery Bypass and Carotid Endarterectomy Ye zhidong, Liu Peng Department of Cardiovascular Surgery China-Japan Friendship Hospital.

BITA Grafting: When to do it (when to not do it ) Joseph F. Sabik, MD Chairman and Professor of Surgery Department of Thoracic and Cardiovascular Surgery.

Coronary Artery Disease in Diabetic Patients, Different from Non-diabetics?

How Many Arterial Grafts is Enough?

André Lamy Population Health Research Institute Hamilton Health Sciences McMaster University Hamilton, CANADA on behalf of the CORONARY Investigators Disclosures.

André Lamy Population Health Research Institute Hamilton Health Sciences McMaster University Hamilton, CANADA on behalf of the CORONARY Investigators Disclosures.

G. Rainey Williams Symposium September 30, 2005 CABG in the Elderly Patient: On or Off pump? A Single Center Experience R. Nathan Grantham, M.D.

MENU ΣΤΕΦΑΝΙΑΙΑ ΝΟΣΟΣ ΣΕ ΔΙΑΒΗΤΙΚΟΥΣ ΚΑΙ ΗΛΙΚΙΩΜΕΝΟΥΣ.

Deep Hypothermic Circulatory Arrest in the Elderly: Is it Safe? Adam D. Zimmet, Irving L. Kron, Alan M. Speir, Clifford E. Fonner, and Ivan K. Crosby University.

Are all forms of total arterial revascularisation equal? A comparison of single versus bilateral internal thoracic artery grafting strategies. William.

Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass surgery in Type-2 Diabetic Patients Akbar.

Ischemia Management with Accupril Post Bypass Graft via Inhibition of Angiotensin Converting Enzyme IMAGINEIMAGINE Presented at The European Society of.

Coronary Artery Surgery 2003 Coronary Artery Surgery Results 2003 Coronary Artery Surgery Results 2003 The Japanese Association for Coronary Artery Surgery.

Date of download: 5/28/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Long-term Risk of Mortality and End-Stage Renal Disease.

Objective Bleeding events are grave and sometimes life threatening complications after prosthetic valve replacement, especially in hemodialysis patients.

Date of download: 7/1/2016 Copyright © The American College of Cardiology. All rights reserved. From: The Scope of Coronary Heart Disease in Patients With.

Neurocognitive dysfunction after Arch replacement Kumamoto central hospital Department of Cardiovascular surgery Nakatsu Taro, Koshiji Takaaki, Sakakibara.

Date of download: 7/8/2016 Copyright © The American College of Cardiology. All rights reserved. From: Procedural Outcomes of Chronic Total Occlusion Percutaneous.

Single IMA {Single Arterial}

Patients Characteristics

Lako S, Daka A, Nurka T, Dedej T, Memishaj S

Is return of angina after coronary artery bypass grafting immutable, can it be delayed, and is it important? P. Sergeant, MD, E. Blackstone, MD*, B.

Factors associated with postoperative atrial fibrillation and other adverse events after cardiac surgery Emmanuel Akintoye, MD, MPH, Frank Sellke, MD,

Early postoperative outcome and medium-term survival in 540 diabetic and 2239 nondiabetic patients undergoing coronary artery bypass grafting Zoltán.

Cyrus J. Parsa, MD, Linda K. Shaw, MS, J. Scott Rankin, MD, Mani A

Similar Outcome in Insulin-Dependent and Noninsulin-Dependent Diabetic Patients After Off-Pump Coronary Artery Bypass Grafting With Multiple Skeletonized.

The impact of placing multiple grafts to each myocardial territory on long-term survival after coronary artery bypass grafting Danny Chu, MD, Faisal.

Long-term outcome of myocardial revascularization in patients with Kawasaki coronary artery disease Soichiro Kitamura, MDa (by invitation), Yoichi Kameda,

Should Bilateral Internal Thoracic Artery Grafting Be Used in Patients With Diabetes Mellitus? Dmitry Pevni, MD, Benjamin Medalion, MD, Rephael Mohr,

One or Two Internal Thoracic Grafts

Coronary revascularization of the circumflex

Does Diabetes Affect the Postoperative Outcomes After Total Arterial Off-Pump Coronary Bypass Surgery in Multivessel Disease? Jae-Sung Choi, MD, PhD,

Long-term outcomes of coronary artery bypass grafting patients supported preoperatively with an intra-aortic balloon pump Eli Hemo, MD, Benjamin Medalion,

Shikhar Agarwal, MD, MPH, Aatish Garg, MD, Akhil Parashar, MD, Lars G

Is return of angina after coronary artery bypass grafting immutable, can it be delayed, and is it important? P. Sergeant, MD, E. Blackstone, MD*, B.

Surgical revascularization techniques that minimize surgical risk and maximize late survival after coronary artery bypass grafting in patients with diabetes.

Coronary artery bypass grafting using the gastroepiploic artery in 1,000 patients Hitoshi Hirose, MD, Atushi Amano, MD, Shuichirou Takanashi, MD, Akihito.

Early and long-term outcomes of coronary artery bypass grafting in patients with acute coronary syndrome versus stable angina pectoris Toshihiro Fukui,

Off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial Umberto Benedetto, MD, PhD, Douglas G. Altman,

A decade after the Surgical Treatment for Ischemic Heart Failure (STICH) trial: Weaving firm clinical recommendations from lessons learned Robert E.

Long-Term Survival After Coronary Arterial Grafts in Patients With End-Stage Renal Disease Taro Nakatsu, MD, Nobushige Tamura, MD, PhD, Yutaka Sakakibara,

The effect of coronary artery bypass grafting on specific causes of long-term mortality in the Bypass Angioplasty Revascularization Investigation David.

Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity Joseph C Cleveland, MD, A.Laurie W Shroyer, PhD, Anita Y Chen,

Is the second internal thoracic artery better than the radial artery in total arterial off- pump coronary artery bypass grafting? A propensity score–matched.

Bilateral versus single internal thoracic artery grafting in oral-treated diabetic subsets: comparative seven-year outcome analysis Oren Lev-Ran, MD,

Two internal thoracic artery grafts are better than one

Impact of the second internal thoracic artery on short- and long-term outcomes in obese patients: A propensity score matched analysis Umberto Benedetto,

Pulse pressure for selecting the optimal cardiac strategy in patients with type 2 diabetes and coronary artery disease Tetsuro Tsujimoto, Hiroshi Kajio

Hisato Takagi, MD, PhD, Takuya Umemoto, MD, PhD

Early and Midterm Results of Off-Pump Coronary Artery Bypass Grafting

Deep Sternal Wound Infection: Risk Factors and Outcomes

Joseph F. Sabik, MD, Gabriel Olivares, MD, Sajjad Raza, MD, Bruce W

The Journal of Thoracic and Cardiovascular Surgery

Does grafting of the left anterior descending artery with the in situ right internal thoracic artery have an impact on late outcomes in the context of.

Total Arterial Off-Pump Coronary Surgery: Time to Change Our Habits?

Assessment of independent predictors for long-term mortality between women and men after coronary artery bypass grafting: Are women different from men?

Left Main Coronary Artery Disease Does Not Affect the Outcome of Off-Pump Coronary Artery Bypass Grafting Tomoaki Suzuki, MD, PhD, Tohru Asai, MD, PhD,

Internal thoracic artery grafts for the entire heart at a mean of 12 years Lester R Sauvage, MD, Joshua G Rosenfeld, Paul V Roby, MD, David M Gartman,

On-pump versus off-pump coronary artery bypass grafting: impact on postoperative renal failure requiring renal replacement therapy Jan Bucerius, MD,

Proposed future revascularisation strategy in patients with ESRD based on our current results and previous guideline recommendations. Proposed future revascularisation.

Magnus Dalén, MD, Torbjörn Ivert, MD, PhD, Martin J

Presentation transcript:

Department of cardiovascular surgery Kumamoto Central Hospital Taro Nakatsu, Nobushige Tamura, Takuya Nomoto, Koji Hagio, Masanosuke Ishigami, Shouichi Kyo

Bilateral internal thoracic artery (BITA) grafting is known to improve the long-term survival after coronary artery bypass grafting (CABG). However, there are few reports regarding the efficacy of BITA grafting in end-stage renal disease (ESRD) patients.

~ ESRD patients underwent CABG. 130 patients had CABG with ITAs. SITA 81 patients BITA 49 patients Operation Arrest90 patients VF9 patients On Pump Beating12 patients OPCAB19 patients

Follow up duration 5.2±3.8 years 83 patients (63.8%) : Dead Survival Cardiac death Hospital death Cardiogenic death Sudden death Cardiac event Cardiac death Myocardial infarction Reccurent angina Repeated CABGs Repeated PCIs

Characteristic SITA (n = 81) BITA (n = 49) P value Age63.8± ±7.4NS Male 64 (79.0%) 41 (83.7%) NS HT 70 (86.4%) 40 (81.6%) NS HL 23 (28.4%) 20 (40.8%) NS DM 49 (60.5%) 20 (40.8%) Insulin 27 (33.3%) 11 (22.4%) NS CVD 14 (17.3%) 9 (18.4%) NS PVD 22 (27.2%) 10 (20.4%) NS OMI 28 (34.6%) 15 (30.6%) NS Characteristic SITA (n = 81) BITA (n = 49) P value Obesity (BMI>26) 7 (8.6%) 5 (10.2%) NS HD duration5.8±5.09.1± EF64±1465±14NS LMT disease 24 (29.6%) 21 (42.9%) NS 3VD 55 (67.9%) 38 (77.6%) NS 2VD 22 (27.2%) 7 (14.3%) NS 1VD 4 (4.9%) 0NS

Variable LITARITA SITA LAD 73 (90%)3 (3.7%) Diag or HL 1 (1.2%)- LCx 4 (4.9%)- BITA LAD 36 (73%)11(22%) Diag or HL 2 (4.1%)6(12%) LCx 11 (22%)32 (65%)

SITABITAP value n14145 SVG98.6%93.3% n1617 GEA93.8%100% n343 RITA100% 1 n6943 LITA98.6%100%0.3974

SITA (n = 81) BITA (n = 49) P value Emergent case11(13.5%)1(2.0%) Anastomosis3.1±1.13.5± Use of GEA16 (19.8%) 19 （ 38.8%) Off pump9 (11.1%)10(20.4%) Operation time310±67368±71< CPB time133±42120± Cross-clamp time85±2775±

SITA (n = 81) BITA (n = 49) P value In hospital Mortality4 (4.9%)2(4.1%) Rethoracotomy1 (1.1%)1 (2.0%) Mediastinitis2 (2.5%)2(4.1%)0.605 Perioperative myocardial infarction 4 (4.9%) Stroke1 (1.1%)2(4.1%) Intestinal complication4 (4.9%)1 (2.0%) Multiple organ failure2 (2.5%)2(4.1%)0.605

survival Time(years) No. at risk SITA BITA BITA SITA P = % 40% 60% 80% 100% 3 years5 years7 years10 years SITA79.6%62.5%43.6%22.6% BITA76.0%61.9%58.8%33.2%

No. at risk SITA BITA % 40% 60% 80% 100% BITA SITA Time(years) Cumulative Freedom from Cardiac death P = years5 years7 years10 years SITA87.1 %80.6%70.7%43.4% BITA85.1%75.3% 60.8%

No. at risk SITA BITA % 40% 60% 80% 100% Time(years) Cumulative Freedom from Cardiac event BITA SITA P = years5 years7 years10 years SITA73.9%64.2%51.1%24.6% BITA77.7%60.9%49.6%39.1%

DM patients 69 patients (SITA 49 patients, BITA 20 patients) Non DM patients 61 patients (SITA 32 patients, BITA 29 patients)

Characteristic SITA (n = 49) BITA (n = 20) P value Age64.4± ±7.0NS Male 38 (77.6%) 15 (75.0%) NS HT 13 (26.5%) 8 (40.0%) NS HL 23 (28.4%) 20 (40.8%) NS Insulin 27 (55.1%) 11 (55.0%) NS Hb A1c6.9±1.16.4±0.87NS CVD 10 (20.4%) 3 (15.0%) NS PVD 18 (36.7%) 7 (35.0%) NS OMI 18 (36.7%) 4 (20.0%) NS Characteristic SITA (n = 49) BITA (n = 20) P value Obesity (BMI>26) 6 (12.2%) 1 (5.0%) NS HD duration4.5±3.96.1±4.7 NS EF65±1464±15NS LMT disease 15 (30.6%) 10 (50.0%) NS 3VD 36 (73.5%) 14 (70.0%) NS 2VD 9 (27.2%) 6 (30.0%) NS 1VD 2 (4.1%) 0NS

No. at risk SITA BITA P = BITA SITA years survival 0 20% 40% 60% 80% 100% 3 years5 years7 years10 years SITA82.4%63.8%45.9%17.9% BITA82.5%56.6% 9.4%

No. at risk SITA BITA P = BITA SITA years Cumulative Freedom from Cardiac Death 20% 40% 60% 80% 100% 0 3 years5 years7 years10 years SITA93.3%87.1%72.0%42.3% BITA86.8%77.2% 34.3%

No. at risk SITA BITA P = BITA SITA years Cumulative Freedom from Cardiac Event 20% 40% 60% 80% 100% years5 years7 years10 years SITA85.1%79.1%68.4%35.3% BITA62.9%52.4%39.3%0

Characteristic SITA (n = 32) BITA (n = 29) P value Age62.8± ±7.8NS Male 26 (81.3%) 26 (89.7%) NS HT 27 (84.4%) 24 (82.8%) NS HL 10 (31.3%) 12 (41.4%) NS CVD 4 (12.5%) 6 (20.7%) NS PVD 4 (12.5%) 3 (10.3%) NS OMI 10 (31.3%) 11 (37.9%) NS Characteristic SITA (n = 32) BITA (n = 29) P value Obesity (BMI>26) 1 (3.1%) 4 (13.8%) NS HD duration7.7± ±8.0 NS EF62±1465±14NS LMT disease 9 (28.1%) 11 (37.9%) NS 3VD 18 (56.3%) 23 (79.3%) VD 11 (34.3%) 5 (17.2%) NS 1VD 1 (3.1%) 0NS

No. at risk SITA BITA % 40% 60% 80% 100% P = BITA SITA years survival 3 years5 years7 years10 years SITA75.0%59.4%40.4%28.3% BITA73.1%64.5%59.9%47.9%

P = BITA SITA No. at risk SITA BITA years Cumulative Freedom from Cardiac Death 20% 40% 60% 80% 100% 0 3 years5 years7 years10 years SITA77.7%70.9%61.8%43.3% BITA84.2%74.3%

BITA SITA P = No. at risk SITA BITA % 40% 60% 80% 100% 0 Time(years) Cumulative Freedom from Cardiac event 3 years5 years7 years10 years SITA58.4%44.7%35.5%11.8% BITA84.0%64.2%53.4%

Bilateral internal thoracic artery grafting produces improved survival compared with single internal thoracic artery grafting during the second postoperative decade.

ESRD patients with diabetes mellitus have a increased risk of death 10 years survival BITA:17.9% SITA: 9.4%. Therefore, BITA grafting might confer few advantages for long term survivals.

After a long-term follow-up, CABG with BITA grafts showed no advantages in the long-term outcomes among ESRD patients. For ESRD patients without diabetes mellitus, BITA grafting may provide more promising long-term freedom from cardiac events ratio.