title: Urgent Coronary Revascularization with Bilateral Internal Thoracic Artery Grafting: Is the Risk Justified?
abstract: BackgroundThe frequent need of immediate institution of cardiopulmonary bypass because of ischemia and increased risk of bleeding and longer duration of surgery limit the use of bilateral internal thoracic artery (BITA) grafting in urgency.Patients and MethodsOf 4,525 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery at the authors' institution (1999-September 2015), 121 (2.7%) patients had an operation before the beginning of the next working day after decision to operate, which is the definition for emergency according to the European System for Cardiac Operative Risk Evaluation II. BITA and single internal thoracic artery (SITA) grafting were used in 52 and 46 of these patients, respectively; venous grafts alone were used in the remaining cases. BITA and SITA patients were compared as risk profiles, operative data, and outcomes. A propensity score (PS)-matched analysis was also performed.ResultsBetween BITA and SITA patients, there was no significant difference as hospital mortality, both in the overall (3.8 vs. 6.5%;p= 0.66) and the PS-matched series (0 vs. 4.3%;p= 1). Among the postoperative complications, only bleeding (but not blood transfusion nor mediastinal re-exploration) was increased both in the overall (p= 0.037) and the PS-matched series of BITA patients (p= 0.092); duration of surgery was increased but not quite significantly (p= 0.12). Freedom from cardiac and cerebrovascular deaths, and major adverse cardiac and cerebrovascular events were higher in PS-matched BITA patients, even though not quite significantly (p= 0.11 for both).ConclusionBITA grafting may be performed even in urgency. With respect to SITA grafting, hospital mortality and postoperative complications other than bleeding are not increased; late outcomes seem to be better.
authors.affiliation: Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.affiliation: Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Maschietto
authors.affiliation: Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Benussi
authors.affiliation: Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Lorella
authors.initials: L
authors.lastname: Dreas
authors.affiliation: Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Forti
authors.affiliation: Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Aniello
authors.initials: A
authors.lastname: Pappalardo
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019106:Postoperative Hemorrhage / Q000209:etiology; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome