PMID- 15615352
OWN - NLM
STAT- MEDLINE
DCOM- 20050131
LR  - 20061115
IS  - 1129-4728 (Print)
IS  - 1129-4728 (Linking)
VI  - 5
IP  - 10
DP  - 2004 Oct
TI  - [Use of skeletonized double mammary arteries for emergency/urgency myocardial 
      revascularization in unstable angina: technical aspects and long-term outcome].
PG  - 806-15
AB  - BACKGROUND: Surgical revascularization employing bilateral internal mammary 
      arteries (IMAs) is an excellent procedure in elective surgery, but its role in 
      urgent/emergent procedures is still debating. This retrospective study evaluates 
      the feasibility, safety and surgical early outcomes of employing double 
      skeletonized IMAs in patients with unstable angina (UA) undergoing 
      urgent/emergent revascularization. METHODS: From January 1997 to May 2004, 824 
      patients (491 males, 333 females, mean age 64 +/- 12 years) underwent urgent 
      revascularization for UA. Bilateral IMAs were employed in 346 (42%) patients 
      (group B) and isolated and/or saphenous vein grafts in the remaining 478 (58%) 
      patients (group M). There were no significant differences in preoperative risk 
      factors between the two groups (mean EuroSCORE value). RESULTS: Postoperative 
      stay was free from complications in 87% of patients of group B and 91% of group 
      M. In-hospital mortality (group B 5.9%, group M 5.3%, p = NS) and perioperative 
      myocardial infarction (group B 2.2%, group M 1.96%, p = NS), mean coronary care 
      unit stay and total hospital stay were similar in both groups. Actuarial survival 
      at 1, 3, 5 and 7 years was respectively 98.7, 97.5, 96.9 and 96.1% in group B and 
      99, 93.4, 92.1 and 88.4% in group M (p < 0.05). At a mean follow-up of 6.6 years 
      the event-free survival (p = 0.021) and reoperation-free cardiac survival (p = 
      0.003) were better in group B. Multivariate analysis identified that age > 65 
      years (p = 0.01), congestive heart failure (p = 0.001), left ventricular ejection 
      fraction < 35% (p = 0.03), and > 1 ischemic irreversible area (p = 0.02) are 
      negative predictors for reoperation-free cardiac survival. The employment of the 
      left IMA (p = 0.006) and of both IMAs (p = 0.001) were positive predictors for 
      the overall survival and reoperation-free cardiac survival. CONCLUSIONS: Our 
      results show that the use of skeletonized bilateral IMAs is associated with an 
      acceptable risk and a lower incidence of postoperative complications in patients 
      with UA, improving late outcomes in this group of patients.
FAU - Battaglia, Francesco
AU  - Battaglia F
AD  - Cattedra e Scuola di Specializzazione in Cardiochirurgia, Universita degli Studi, 
      Firenze. fbattaglia@unifi.it
FAU - Maiani, Massimo
AU  - Maiani M
FAU - Prifti, Edvin
AU  - Prifti E
FAU - Leacche, Marzia
AU  - Leacche M
FAU - Bonacchi, Massimo
AU  - Bonacchi M
LA  - ita
PT  - Comparative Study
PT  - English Abstract
PT  - Journal Article
TT  - Uso della doppia arteria mammaria scheletrizzata per la rivascolarizzazione 
      miocardica d'urgenza/emergenza nell'angina instabile: aspetti tecnici, risultati 
      perioperatori ed a lungo termine.
PL  - Italy
TA  - Ital Heart J Suppl
JT  - Italian heart journal. Supplement : official journal of the Italian Federation of 
      Cardiology
JID - 101223651
SB  - IM
MH  - Actuarial Analysis
MH  - Aged
MH  - Angina, Unstable/*surgery
MH  - *Coronary Artery Bypass
MH  - Emergencies
MH  - Feasibility Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Mammary Arteries
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Postoperative Complications
MH  - Reoperation
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Saphenous Vein/transplantation
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2004/12/24 09:00
MHDA- 2005/02/03 09:00
CRDT- 2004/12/24 09:00
PHST- 2004/12/24 09:00 [pubmed]
PHST- 2005/02/03 09:00 [medline]
PHST- 2004/12/24 09:00 [entrez]
PST - ppublish
SO  - Ital Heart J Suppl. 2004 Oct;5(10):806-15.