Two internal thoracic artery grafts are better than one

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Presentation transcript:

Two internal thoracic artery grafts are better than one Bruce W. Lytle, MD, Eugene H. Blackstone, MD, Floyd D. Loop, MD, Penny L. Houghtaling, MS, John H. Arnold, MD, Rami Akhrass, MD, Patrick M. McCarthy, MD, Delos M. Cosgrove, MD The Journal of Thoracic and Cardiovascular Surgery Volume 117, Issue 5, Pages 855-872 (May 1999) DOI: 10.1016/S0022-5223(99)70365-X Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 1 Comparison of the bilateral ITA (BITA) and single ITA (SITA) groups in terms of survival (A) and reoperation-free survival (B). Numbers of patients surviving at selected follow-up intervals are listed beneath part A. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 855-872DOI: (10.1016/S0022-5223(99)70365-X) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 2 Comparison of survival and reoperation hazard function curves in the propensity-matched patients (both P < .0001) (bilateral [BITA], n = 1989; single [SITA], n = 4147). CABG, Coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 855-872DOI: (10.1016/S0022-5223(99)70365-X) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 3 Distribution of Cox hazard ratios for 1000 “bootstrap” samples tested for the influence of bilateral versus single ITA grafts on the occurrence of death, PTCA, and reoperation. Any Cox hazard ratio greater than 1 indicates an advantage for bilateral ITA grafting. All hazard ratios for all samples were greater than 1. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 855-872DOI: (10.1016/S0022-5223(99)70365-X) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 4 Nonproportional hazard equations were solved twice for each propensity-matched patient, once as if the patient had single ITA grafting and once as if the patient had bilateral ITA grafting. The distribution of the percentage differences in outcomes for all patients based on bilateral versus single ITA grafting are shown in this figure. All patients had better predicted outcomes with bilateral ITA grafting. The percentage of the patient population is expressed vertically and the percent difference in the occurrence of each event is expressed horizontally. The table details percent differences at selected percentages of the entire patient population. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 855-872DOI: (10.1016/S0022-5223(99)70365-X) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 5 Non-risk-adjusted age relation to survival and freedom from reoperation at 12 postoperative years for propensity-matched patients based on nonproportional hazard equations. The survival curve confidence limits of patients having bilateral (BITA) and single (SITA) ITA grafting overlap at young ages. Bilateral ITA grafting produces significantly better freedom from reoperation at all ages and better survival at older ages. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 855-872DOI: (10.1016/S0022-5223(99)70365-X) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 6 Non-risk-adjusted survival curves for diabetic and nondiabetic patients according to bilateral (BITA) versus single (SITA) ITA grafting at 12 postoperative years. For both groups survival for patients having bilateral ITA grafting was better. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 855-872DOI: (10.1016/S0022-5223(99)70365-X) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 7 Twelve-year survival of patients having bilateral (BITA) or single (SITA) ITA grafting according to left ventricular (LV) function (none or mild dysfunction vs moderate or severe dysfunction). For both ventricular function subgroups, survival was better for patients having bilateral ITA grafting. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 855-872DOI: (10.1016/S0022-5223(99)70365-X) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 8 Predicted survival and reoperation hazard function curves according to 1 ITA versus 2 ITAs for a 47-year-old normotensive man with 2-vessel disease and normal left ventricular function (patient 1) and for a 64-year-old hypertensive man with 3-vessel disease and moderate impairment of left ventricular function (patient 2). CABG, Coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 855-872DOI: (10.1016/S0022-5223(99)70365-X) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 9 Predicted survival and reoperation hazard function curves, 1 ITA versus 2 ITAs, for a normotensive 70-year-old man with normal left ventricular function (patient 3) and a 50-year-old hypertensive man with severe left ventricular dysfunction and a history of congestive heart failure (patient 4). The Journal of Thoracic and Cardiovascular Surgery 1999 117, 855-872DOI: (10.1016/S0022-5223(99)70365-X) Copyright © 1999 Mosby, Inc. Terms and Conditions