Dataset Information

Use Rate and Outcome in Bilateral Internal Thoracic Artery Grafting: Insights From a Systematic Review and Meta-Analysis.

ABSTRACT: BACKGROUND:This meta-analysis was designed to assess whether center experience affects the short- and long-term results and the relative benefits of bilateral internal thoracic artery grafting (BITA) for coronary artery bypass grafting. METHODS AND RESULTS:MEDLINE and EMBASE were searched to identify all articles reporting the outcome of BITA in patients undergoing coronary artery bypass grafting. The BITA center experience was gauged according to the percentage use of BITA in the institutional overall coronary artery bypass grafting population (%BITA). The primary outcome was long-term all-cause mortality. Secondary outcomes were operative mortality, perioperative myocardial infarction, perioperative stroke, deep sternal wound infections (DSWIs), and major postoperative adverse event. The rates of the primary and secondary outcomes were calculated after adjusting for %BITA. Primary and secondary outcomes were also compared between the BITA and the single internal thoracic artery arms in the adjusted studies. Meta-regression was used to evaluate the effect of %BITA on the primary and secondary outcomes. Thirty-four studies (27 894 patients undergoing BITA) were included. In the pooled analysis, the incidence rate for long-term mortality was 2.83% (95% confidence interval, 2.21%-3.61%). %BITA was significantly and inversely associated with long-term mortality and the rate of DSWI. In the pairwise comparison, %BITA was significantly and inversely associated with the risk of long-term mortality and DSWI in the group undergoing BITA. CONCLUSIONS:BITA series with higher %BITA report significantly lower long-term mortality and DSWI rate as well as higher long-term survival advantage and lower relative risk of DSWI in their BITA cohort. These findings suggest that a specific volume-outcome relationship exists for BITA grafting.

SUBMITTER: Gaudino M

PROVIDER: S-EPMC6015367 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Use Rate and Outcome in Bilateral Internal Thoracic Artery Grafting: Insights From a Systematic Review and Meta-Analysis.

Gaudino Mario M Bakaeen Faisal F Benedetto Umberto U Rahouma Mohamed M Di Franco Antonino A Tam Derrick Y DY Iannaccone Mario M Schwann Thomas A TA Habib Robert R Ruel Marc M Puskas John D JD Sabik Joseph J Girardi Leonard N LN Taggart David P DP Fremes Stephen E SE

Journal of the American Heart Association 20180517 11

<h4>Background</h4>This meta-analysis was designed to assess whether center experience affects the short- and long-term results and the relative benefits of bilateral internal thoracic artery grafting (BITA) for coronary artery bypass grafting.<h4>Methods and results</h4>MEDLINE and EMBASE were searched to identify all articles reporting the outcome of BITA in patients undergoing coronary artery bypass grafting. The BITA center experience was gauged according to the percentage use of BITA in the ...[more]

PMID: 29773579

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Project description:BACKGROUND:Several risk scores have been created to predict long term mortality after coronary artery bypass grafting (CABG). Several studies demonstrated a reduction in long-term mortality following bilateral internal thoracic arteries (BITA) compared to single internal thoracic artery. However, these prediction models usually referred to long term survival as survival of up to 5 years. Moreover, none of these models were built specifically for operation incorporating BITA grafting. METHODS:A historical cohort study of all patients who underwent isolated BITA grafting between 1996 and 2011 at Tel-Aviv Sourasky medical center, a tertiary referral university affiliated medical center with a 24-bed cardio-thoracic surgery department. Study population (N = 2,935) was randomly divided into 2 groups: learning group which was used to build the prediction model and validation group. Cox regression was used to predict death using pre-procedural risk factors (demographic data, patient comorbidities, cardiac characteristics and patient's status). The accuracy (discrimination and calibration) of the prediction model was evaluated. METHODS AND FINDINGS:The learning (1,468 patients) and validation (1,467 patients) groups had similar preoperative characteristics and similar survival. Older age, diabetes mellitus, chronic obstructive lung disease, congestive heart failure, chronic renal failure, old MI, ejection fraction ?30%, pre-operative use of intra-aortic balloon, and peripheral vascular disease, were significant predictors of mortality and were used to build the prediction model. The area under the ROC curves for 5, 10, and 15-year survival ranged between 0.742 and 0.762 for the learning group and between 0.766 and 0.770 for the validation group. The prediction model showed good calibration performance in both groups. A nomogram was built in order to introduce a simple-to-use tool for prediction of 5, 10, and 15-year survival. CONCLUSIONS:A simple-to-use validated model can be used for a prediction of 5, 10, and 15-year mortality after CABG using the BITA grafting technique.

Dataset Information

Use Rate and Outcome in Bilateral Internal Thoracic Artery Grafting: Insights From a Systematic Review and Meta-Analysis.

Publications

Use Rate and Outcome in Bilateral Internal Thoracic Artery Grafting: Insights From a Systematic Review and Meta-Analysis.

Similar Datasets

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