Abstract | BACKGROUND: Bilateral internal thoracic artery (BITA) grafting is underused in women. METHODS: Outcomes of 798 consecutive women with multivessel coronary disease who underwent isolated coronary surgery (1999-2016) using BITA (n=530, 66.4%) or single internal thoracic artery (SITA) grafting (n=268, 33.6%) were reviewed retrospectively. Differences between BITA and SITA cohort were adjusted by propensity score matching. For both series, late survival was estimated with the Kaplan-Meier method. RESULTS: One-to-one propensity score matching resulted in 247 BITA/SITA pairs with similar baseline characteristics and risk profile. According to the propensity matching, BITA grafting was associated with a trend towards reduced in-hospital mortality (3.2% vs. 5.7%, p=0.19). However, BITA women had an increased chest tube output (p=0.0076) as well as higher rates of any (13% vs. 5.3%, p=0.003) and deep sternal wound infections (9.3% vs. 4.9%, p=0.054), this translating in a longer in- hospital stay (10 vs. 9days, p=0.029). Test for interaction showed that body mass index >30kg/m2 and extracardiac arteriopathy were associated with a higher risk of deep sternal wound infection in BITA than in SITA women (23.4% vs. 13.7%, p<0.001 and 23.9% vs. 3.4%, p=0.001, respectively). Freedom from all-cause death and cardiac or cerebrovascular death were improved in BITA cohort, even though the differences were not quite significant (p=0.16 and 0.076, respectively). CONCLUSIONS: When routinely performed, BITA grafting does not increase in-hospital mortality in women and could improve long-term survival. However, its use should be avoided in obese women with extracardiac arteriopathy because of increased risk of deep sternal wound infection.
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Authors | Giuseppe Gatti, Gianluca Castaldi, Laura Morra, Gabriella Forti, Bernardo Benussi, Gianfranco Sinagra, Aniello Pappalardo |
Journal | International journal of cardiology
(Int J Cardiol)
Vol. 266
Pg. 43-49
(09 01 2018)
ISSN: 1874-1754 [Electronic] Netherlands |
PMID | 29887471
(Publication Type: Journal Article)
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Copyright | Copyright © 2017 Elsevier Ireland Ltd. All rights reserved. |
Topics |
- Aged
- Aged, 80 and over
- Cohort Studies
- Coronary Artery Disease
(mortality, surgery)
- Female
- Follow-Up Studies
- Hospital Mortality
(trends)
- Humans
- Mammary Arteries
(transplantation)
- Middle Aged
- Retrospective Studies
- Survival Rate
(trends)
- Time Factors
- Vascular Grafting
(mortality, trends)
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