Early and late outcomes of single versus bilateral internal thoracic artery revascularization for patients in critical condition.

<h4>Objective</h4>The optimal surgical approach for critically ill patients with complex coronary disease remains uncertain. We compared outcomes of bilateral internal thoracic artery (BITA) versus single ITA (SITA) revascularization in critical patients.<h4>Methods</h4>We ev...

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Autores principales:	Michal Fertouk, Amit Gordon, Dmitry Pevni, Tomer Ziv-Baran, Orr Sela, Rephael Mohr, Ariel Farkash, Amir Kramer, Nadav Teich, Nachum Nesher, Yanai Ben-Gal
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/131968697897449daa19377531f2eec7
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spelling	oai:doaj.org-article:131968697897449daa19377531f2eec72021-12-02T20:15:09ZEarly and late outcomes of single versus bilateral internal thoracic artery revascularization for patients in critical condition.1932-620310.1371/journal.pone.0255740https://doaj.org/article/131968697897449daa19377531f2eec72021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255740https://doaj.org/toc/1932-6203<h4>Objective</h4>The optimal surgical approach for critically ill patients with complex coronary disease remains uncertain. We compared outcomes of bilateral internal thoracic artery (BITA) versus single ITA (SITA) revascularization in critical patients.<h4>Methods</h4>We evaluated 394 consecutive critical patients with multi-vessel disease who underwent CABG during 1996-2001. Outcomes measured were early mortality, strokes, myocardial-infarctions, sternal infections, revisions for bleeding, and late survival. The critical preoperative state was acknowledged concisely by one or more of the following: preoperative ventricular tachycardia/fibrillation, aborted sudden cardiac death, or the need for mechanical ventilation or for preoperative insertion of intra-aortic-balloon counter-pulsation.<h4>Results</h4>During the study period, 193 of our patients who underwent SITA and 201 who underwent BITA were in critical condition. The SITA group was older (mean 68.0 vs. 63.3 years, p = 0.001) and higher proportions were females (28.5% vs. 18.9% p = 0.025), after recent-MI (69.9% vs. 57.2% p = 0.009) and with left-main disease (38.3% vs. 49.3% p = .029); the median logistic EuroSCORE was higher (0.2898 vs. 0.1597, p<0.001). No statistically significant differences were observed between the SITA and BITA groups in 30-day mortality; and in rates of early CVA, MI and sternal infections (13.0% vs. 8.5%, p = 0.148; 4.1% vs. 6.0%, p = 0.49; 6.7% vs. 4.5%, p = 0.32 and 2.1% vs. 2.5%, p>0.99, respectively). Long-term survival (median follow-up of 15 years, interquartile-range: 13.57-15) was better in the BITA group (median 14.39 vs. 9.31± 0.9 years, p = 0.001). Propensity-score matching (132 matched pairs) also yielded similar early outcomes and improved long-term survival (median follow-up of 15 years, interquartile-range: 13.56-15) for the BITA group (median 12.49±1.71 vs. 7.63±0.99 years, p = 0.002). In multivariable analysis, BITA revascularization was found to be a predictor for improved survival (hazard-ratio of 0.419, 95%CI 0.23-0.76, p = 0.004).<h4>Conclusions</h4>This study demonstrated long-term survival benefit for BITA revascularization in patients in a critical pre-operative state who presented for surgical revascularization.Michal FertoukAmit GordonDmitry PevniTomer Ziv-BaranOrr SelaRephael MohrAriel FarkashAmir KramerNadav TeichNachum NesherYanai Ben-GalPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0255740 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Michal Fertouk Amit Gordon Dmitry Pevni Tomer Ziv-Baran Orr Sela Rephael Mohr Ariel Farkash Amir Kramer Nadav Teich Nachum Nesher Yanai Ben-Gal Early and late outcomes of single versus bilateral internal thoracic artery revascularization for patients in critical condition.
description	<h4>Objective</h4>The optimal surgical approach for critically ill patients with complex coronary disease remains uncertain. We compared outcomes of bilateral internal thoracic artery (BITA) versus single ITA (SITA) revascularization in critical patients.<h4>Methods</h4>We evaluated 394 consecutive critical patients with multi-vessel disease who underwent CABG during 1996-2001. Outcomes measured were early mortality, strokes, myocardial-infarctions, sternal infections, revisions for bleeding, and late survival. The critical preoperative state was acknowledged concisely by one or more of the following: preoperative ventricular tachycardia/fibrillation, aborted sudden cardiac death, or the need for mechanical ventilation or for preoperative insertion of intra-aortic-balloon counter-pulsation.<h4>Results</h4>During the study period, 193 of our patients who underwent SITA and 201 who underwent BITA were in critical condition. The SITA group was older (mean 68.0 vs. 63.3 years, p = 0.001) and higher proportions were females (28.5% vs. 18.9% p = 0.025), after recent-MI (69.9% vs. 57.2% p = 0.009) and with left-main disease (38.3% vs. 49.3% p = .029); the median logistic EuroSCORE was higher (0.2898 vs. 0.1597, p<0.001). No statistically significant differences were observed between the SITA and BITA groups in 30-day mortality; and in rates of early CVA, MI and sternal infections (13.0% vs. 8.5%, p = 0.148; 4.1% vs. 6.0%, p = 0.49; 6.7% vs. 4.5%, p = 0.32 and 2.1% vs. 2.5%, p>0.99, respectively). Long-term survival (median follow-up of 15 years, interquartile-range: 13.57-15) was better in the BITA group (median 14.39 vs. 9.31± 0.9 years, p = 0.001). Propensity-score matching (132 matched pairs) also yielded similar early outcomes and improved long-term survival (median follow-up of 15 years, interquartile-range: 13.56-15) for the BITA group (median 12.49±1.71 vs. 7.63±0.99 years, p = 0.002). In multivariable analysis, BITA revascularization was found to be a predictor for improved survival (hazard-ratio of 0.419, 95%CI 0.23-0.76, p = 0.004).<h4>Conclusions</h4>This study demonstrated long-term survival benefit for BITA revascularization in patients in a critical pre-operative state who presented for surgical revascularization.
format	article
author	Michal Fertouk Amit Gordon Dmitry Pevni Tomer Ziv-Baran Orr Sela Rephael Mohr Ariel Farkash Amir Kramer Nadav Teich Nachum Nesher Yanai Ben-Gal
author_facet	Michal Fertouk Amit Gordon Dmitry Pevni Tomer Ziv-Baran Orr Sela Rephael Mohr Ariel Farkash Amir Kramer Nadav Teich Nachum Nesher Yanai Ben-Gal
author_sort	Michal Fertouk
title	Early and late outcomes of single versus bilateral internal thoracic artery revascularization for patients in critical condition.
title_short	Early and late outcomes of single versus bilateral internal thoracic artery revascularization for patients in critical condition.
title_full	Early and late outcomes of single versus bilateral internal thoracic artery revascularization for patients in critical condition.
title_fullStr	Early and late outcomes of single versus bilateral internal thoracic artery revascularization for patients in critical condition.
title_full_unstemmed	Early and late outcomes of single versus bilateral internal thoracic artery revascularization for patients in critical condition.
title_sort	early and late outcomes of single versus bilateral internal thoracic artery revascularization for patients in critical condition.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/131968697897449daa19377531f2eec7
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Early and late outcomes of single versus bilateral internal thoracic artery revascularization for patients in critical condition.

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