PMID- 28958050
OWN - NLM
STAT- MEDLINE
DCOM- 20191115
LR  - 20191115
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 53
IP  - 2
DP  - 2018 Feb 1
TI  - A second arterial conduit to the circumflex circulation significantly improves 
      survival after coronary artery bypass surgery.
PG  - 455-462
LID - 10.1093/ejcts/ezx337 [doi]
AB  - OBJECTIVES: Conventional coronary artery bypass surgery involves the use of a 
      single left internal mammary artery to the left anterior descending artery and 
      saphenous vein grafts reserved for other sites. This retrospective 
      propensity-matched study investigated the impact of a second arterial conduit to 
      the left-sided circulation on early and long-term survival after coronary artery 
      bypass surgery. METHODS: Data were retrospectively collected from 2004 to 2014 
      for all revascularizations with at least 1 arterial and/or 1 venous graft to the 
      circumflex circulation, in addition to an internal mammary artery to the left 
      anterior descending artery. Propensity-matched groups were created based on 
      baseline characteristics. Hazard functions were estimated using Cox multivariable 
      regression, and the Kaplan-Meier survival curves were compared between the 
      matched cohorts. RESULTS: A total of 1226 patients with a venous conduit to the 
      left-sided circulation were successfully matched to an equal number of patients 
      with an arterial conduit. Regression analysis identified a second arterial 
      conduit, logistic European System for Cardiac Operative Risk Evaluation score 
      (EuroSCORE), pulmonary disease, left ventricular ejection fraction, New York 
      Heart Association (NYHA) Class and previous myocardial infarction as significant 
      predictors of survival. A second arterial graft to the left circumflex 
      circulation was a predictor of improved survival (hazard ratio 0.64, 95% 
      confidence interval 0.51-0.80; P < 0.001). There were significant early and late 
      survival benefits (arterial vs venous: 98.2% vs 96.3%, P = 0.003 at 1 year; 82.4% 
      vs 62.2%, P < 0.001 at 10 years) from a second arterial conduit to the circumflex 
      circulation. CONCLUSIONS: There are significant early and late incremental 
      survival benefits from a second arterial conduit to the circumflex circulation.
CI  - (c) The Author 2017. Published by Oxford University Press on behalf of the European 
      Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Luthra, Suvitesh
AU  - Luthra S
AD  - Division of Cardiac Surgery, Derriford Hospital, Plymouth, Devon, UK.
FAU - Leiva-Juarez, Miguel M
AU  - Leiva-Juarez MM
AD  - Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, TX, USA.
FAU - John, Anil
AU  - John A
AD  - Division of Cardiac Surgery, Derriford Hospital, Plymouth, Devon, UK.
FAU - Matuszewski, Maciej
AU  - Matuszewski M
AD  - Department of Cardiothoracic Surgery, New Cross Hospital, Wolverhampton, West 
      Midlands, UK.
FAU - Morgan, Ian S
AU  - Morgan IS
AD  - Department of Cardiothoracic Surgery, New Cross Hospital, Wolverhampton, West 
      Midlands, UK.
FAU - Billing, John S
AU  - Billing JS
AD  - Department of Cardiothoracic Surgery, New Cross Hospital, Wolverhampton, West 
      Midlands, UK.
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Aged
MH  - *Coronary Artery Bypass/instrumentation/methods/mortality
MH  - Coronary Artery Disease/surgery
MH  - Female
MH  - Humans
MH  - Male
MH  - Mammary Arteries/transplantation
MH  - Middle Aged
MH  - Propensity Score
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Coronary artery bypass grafts
OT  - Coronary artery bypass surgery
OT  - Coronary artery disease
OT  - Coronary revascularization
EDAT- 2017/09/29 06:00
MHDA- 2019/11/16 06:00
CRDT- 2017/09/29 06:00
PHST- 2017/03/09 00:00 [received]
PHST- 2017/07/30 00:00 [revised]
PHST- 2017/08/07 00:00 [accepted]
PHST- 2017/09/29 06:00 [pubmed]
PHST- 2019/11/16 06:00 [medline]
PHST- 2017/09/29 06:00 [entrez]
AID - 4157353 [pii]
AID - 10.1093/ejcts/ezx337 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2018 Feb 1;53(2):455-462. doi: 10.1093/ejcts/ezx337.