Grau J.B.,Columbia University |
Grau J.B.,University of Pennsylvania |
Ferrari G.,University of Pennsylvania |
Mak A.W.C.,The Valley Columbia Heart Center |
And 5 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2012
Objectives: Bilateral internal mammary arteries (BIMA) remains widely underutilized in coronary artery bypass grafting (CABG).Although prior research has demonstrated a long-term benefit of the use of BIMA over left internal mammary artery (LIMA)-only, validation of these results is lacking in a contemporary surgical experience. We compared complications and survival at 17-year follow-up in a large series of consecutive CABG patients from a single institution that underwent BIMA grafting with a propensity-matched group where LIMA only was used. Methods: Propensity scores representing the estimated probabilities of patients receiving either BIMA or LIMA alone were developed based on 22 observed baseline covariates in a logistic regression model with procedure group as the dependent variable. The nearestneighbour- matching algorithm with Greedy 5-1 Digit Matching was used to produce two patient cohorts of 928 patients each balanced for baseline factors. We compared 30-day morbidity and mortality, as well as long-term survival at 5-year intervals up to 17-year follow-up. Results: In-hospital and 30-day mortality was 0.8% for the BIMA group and 1.1% for the LIMA-saphenous vein grafting (SVG). No significant difference was found in complications, mortality and/or length-of-stay between these two groups. Off-pump was done in 48.9% of BIMA cases and 51.3% of LIMA cases. Regardless of the types of grafts used, on-pump patients were more likely to have postoperative permanent strokes and longer postoperative lengths of stay. Use of the BIMA over LIMA-only had a statistically significant impact conferring a 10% survival advantage at 10-year and 18% at 15-year follow-up. The Kaplan-Meier survival curves comparing off-/on-pump BIMA and off-/on-pump LIMA-SVG patients demonstrated a 22% survival advantage for off-pump BIMA patients when compared with on-pump LIMA-SVG patients at 15-year follow-up.Conclusions: Perioperative complications do not increase with the use of BIMAs. Long-term survival is optimized with off-pump CABG and BIMA grafting. The low morbidity and mortality rates in this series are likely due to the continuous evolution of technology and the adoption of less invasive options for CABG patients. A more widespread use of BIMAs in CABGpatients would continue to improve the overall excellent short- and long-term results of this operation. © The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Ferrari G.,The Valley Columbia Heart Center |
Ferrari G.,University of Pennsylvania |
Quackenbush J.,Dana-Farber Cancer Institute |
Strobeck J.,The Valley Columbia Heart Center |
And 11 more authors.
Genomics | Year: 2014
In coronary artery bypass grafting (CABG), the combined use of left and right internal mammary arteries (LIMA and RIMA) - collectively known as bilateral IMAs (BIMAs) provides a survival advantage over the use of LIMA alone. However, gene expression in RIMA has never been compared to that in LIMA. Here we report a genome-wide transcriptional analysis of BIMA to investigate the expression profiles of these conduits in patients undergoing CABG. As expected, in comparing the BIMAs to the aorta, we found differences in pathways and processes associated with atherosclerosis, inflammation, and cell signaling - pathways which provide biological support for the observation that BIMA grafts deliver long-term benefits to the patients and protect against continued atherosclerosis. These data support the widespread use of BIMAs as the preferred conduits in CABG. © 2014 Elsevier Inc.
PubMed | The Valley Columbia Heart Center
Type: Case Reports | Journal: The Journal of heart valve disease | Year: 2010
The case is reported of a patient who underwent aortic valve replacement (AVR) in 1969 and received a (first-generation) Bjrk-Shiley Delrin valve. Forty years later, the patient presented to the authors hospital in congestive heart failure and with echocardiographic evidence of severe stenosis and mild aortic regurgitation. The patient underwent a redo sternotomy and AVR with a bioprosthesis. On gross examination, the explanted 40-year-old mechanical valve appeared intact.