Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly

Antonino S. Rubino, Giuseppe Gatti, Daniel Reichart, Tuomas Tauriainen, Marisa De Feo, Francesco Onorati, Aniello Pappalardo, Sidney Chocron, Helmut Gulbins, Magnus Dalén, Peter Svenarud, Giuseppe Faggian, Ilaria Franzese, Giuseppe Santarpino, Theodor Fischlein, Daniele Maselli, Saverio Nardella, Riccardo Gherli, Aamer Ahmed, Francesco SantiniAntonio Salsano, Francesco Nicolini, Marco Zanobini, Matteo Saccocci, Vito G. Ruggieri, Karl Bounader, Carmelo Mignosa, Paola D'Errigo, Stefano Rosato, Juhani Airaksinen, Andrea Perrotti, Fausto Biancari

Research output: Contribution to journalArticle

Abstract

Background: Bilateral internal mammary artery (BIMA) grafting is increasingly used in elderly patients without evidence of its risks or benefits compared with single internal mammary artery (SIMA) grafting. Methods: In all, 2,899 patients aged 70 years or older (855 [29.5%] underwent BIMA grafting) operated on from January 2015 to December 2016 and included in the prospective multicenter Outcome After Coronary Artery Bypass Grafting (E-CABG) study were considered in this analysis. Results: One-to-one propensity matching resulted in 804 pairs with similar preoperative risk profile. Propensity score matched analysis showed that BIMA grafting was associated with a nonstatistically significant increased risk of inhospital death (2.7% versus 1.6%, p = 0.117). The BIMA grafting cohort had a significantly increased risk of any sternal wound infection (7.7% versus 5.1%, p = 0.031) as well as higher risk of deep sternal wound infection/mediastinitis (4.0% versus 2.2%, p = 0.048). The BIMA grafting cohort required more frequently extracorporeal membrane oxygenation (1.0% versus 0.1%, p = 0.02), and the intensive care unit stay (mean 3.6 versus 2.6 days, p < 0.001) and inhospital stay (mean 11.3 versus 10.0 days, p < 0.001) were significantly longer compared with the SIMA grafting cohort. Test for interaction showed that urgent operation in patients undergoing BIMA grafting was associated with higher risk of inhospital death (5.6% versus 1.3%, p = 0.009). Conclusions: Bilateral internal mammary artery grafting in elderly patients seems to be associated with a worse early outcome compared with SIMA grafting, particularly in patients undergoing urgent operation. Until more conclusive results are gathered, BIMA grafting should be reserved only for elderly patients with stable coronary artery disease, without significant baseline comorbidities and with long life expectancy.

Original languageEnglish
Pages (from-to)1717-1723
Number of pages7
JournalAnnals of Thoracic Surgery
Volume105
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

Fingerprint

Mammary Arteries
Wound Infection
Mediastinitis
Propensity Score
Extracorporeal Membrane Oxygenation
Life Expectancy
Coronary Artery Bypass
Intensive Care Units
Comorbidity
Coronary Artery Disease

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Rubino, A. S., Gatti, G., Reichart, D., Tauriainen, T., De Feo, M., Onorati, F., ... Biancari, F. (2018). Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly. Annals of Thoracic Surgery, 105(6), 1717-1723. https://doi.org/10.1016/j.athoracsur.2017.11.079

Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly. / Rubino, Antonino S.; Gatti, Giuseppe; Reichart, Daniel; Tauriainen, Tuomas; De Feo, Marisa; Onorati, Francesco; Pappalardo, Aniello; Chocron, Sidney; Gulbins, Helmut; Dalén, Magnus; Svenarud, Peter; Faggian, Giuseppe; Franzese, Ilaria; Santarpino, Giuseppe; Fischlein, Theodor; Maselli, Daniele; Nardella, Saverio; Gherli, Riccardo; Ahmed, Aamer; Santini, Francesco; Salsano, Antonio; Nicolini, Francesco; Zanobini, Marco; Saccocci, Matteo; Ruggieri, Vito G.; Bounader, Karl; Mignosa, Carmelo; D'Errigo, Paola; Rosato, Stefano; Airaksinen, Juhani; Perrotti, Andrea; Biancari, Fausto.

In: Annals of Thoracic Surgery, Vol. 105, No. 6, 01.06.2018, p. 1717-1723.

Research output: Contribution to journalArticle

Rubino, AS, Gatti, G, Reichart, D, Tauriainen, T, De Feo, M, Onorati, F, Pappalardo, A, Chocron, S, Gulbins, H, Dalén, M, Svenarud, P, Faggian, G, Franzese, I, Santarpino, G, Fischlein, T, Maselli, D, Nardella, S, Gherli, R, Ahmed, A, Santini, F, Salsano, A, Nicolini, F, Zanobini, M, Saccocci, M, Ruggieri, VG, Bounader, K, Mignosa, C, D'Errigo, P, Rosato, S, Airaksinen, J, Perrotti, A & Biancari, F 2018, 'Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly', Annals of Thoracic Surgery, vol. 105, no. 6, pp. 1717-1723. https://doi.org/10.1016/j.athoracsur.2017.11.079
Rubino, Antonino S. ; Gatti, Giuseppe ; Reichart, Daniel ; Tauriainen, Tuomas ; De Feo, Marisa ; Onorati, Francesco ; Pappalardo, Aniello ; Chocron, Sidney ; Gulbins, Helmut ; Dalén, Magnus ; Svenarud, Peter ; Faggian, Giuseppe ; Franzese, Ilaria ; Santarpino, Giuseppe ; Fischlein, Theodor ; Maselli, Daniele ; Nardella, Saverio ; Gherli, Riccardo ; Ahmed, Aamer ; Santini, Francesco ; Salsano, Antonio ; Nicolini, Francesco ; Zanobini, Marco ; Saccocci, Matteo ; Ruggieri, Vito G. ; Bounader, Karl ; Mignosa, Carmelo ; D'Errigo, Paola ; Rosato, Stefano ; Airaksinen, Juhani ; Perrotti, Andrea ; Biancari, Fausto. / Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly. In: Annals of Thoracic Surgery. 2018 ; Vol. 105, No. 6. pp. 1717-1723.
@article{0dffdbed98f54a90b26574628d210e7a,
title = "Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly",
abstract = "Background: Bilateral internal mammary artery (BIMA) grafting is increasingly used in elderly patients without evidence of its risks or benefits compared with single internal mammary artery (SIMA) grafting. Methods: In all, 2,899 patients aged 70 years or older (855 [29.5{\%}] underwent BIMA grafting) operated on from January 2015 to December 2016 and included in the prospective multicenter Outcome After Coronary Artery Bypass Grafting (E-CABG) study were considered in this analysis. Results: One-to-one propensity matching resulted in 804 pairs with similar preoperative risk profile. Propensity score matched analysis showed that BIMA grafting was associated with a nonstatistically significant increased risk of inhospital death (2.7{\%} versus 1.6{\%}, p = 0.117). The BIMA grafting cohort had a significantly increased risk of any sternal wound infection (7.7{\%} versus 5.1{\%}, p = 0.031) as well as higher risk of deep sternal wound infection/mediastinitis (4.0{\%} versus 2.2{\%}, p = 0.048). The BIMA grafting cohort required more frequently extracorporeal membrane oxygenation (1.0{\%} versus 0.1{\%}, p = 0.02), and the intensive care unit stay (mean 3.6 versus 2.6 days, p < 0.001) and inhospital stay (mean 11.3 versus 10.0 days, p < 0.001) were significantly longer compared with the SIMA grafting cohort. Test for interaction showed that urgent operation in patients undergoing BIMA grafting was associated with higher risk of inhospital death (5.6{\%} versus 1.3{\%}, p = 0.009). Conclusions: Bilateral internal mammary artery grafting in elderly patients seems to be associated with a worse early outcome compared with SIMA grafting, particularly in patients undergoing urgent operation. Until more conclusive results are gathered, BIMA grafting should be reserved only for elderly patients with stable coronary artery disease, without significant baseline comorbidities and with long life expectancy.",
author = "Rubino, {Antonino S.} and Giuseppe Gatti and Daniel Reichart and Tuomas Tauriainen and {De Feo}, Marisa and Francesco Onorati and Aniello Pappalardo and Sidney Chocron and Helmut Gulbins and Magnus Dal{\'e}n and Peter Svenarud and Giuseppe Faggian and Ilaria Franzese and Giuseppe Santarpino and Theodor Fischlein and Daniele Maselli and Saverio Nardella and Riccardo Gherli and Aamer Ahmed and Francesco Santini and Antonio Salsano and Francesco Nicolini and Marco Zanobini and Matteo Saccocci and Ruggieri, {Vito G.} and Karl Bounader and Carmelo Mignosa and Paola D'Errigo and Stefano Rosato and Juhani Airaksinen and Andrea Perrotti and Fausto Biancari",
year = "2018",
month = "6",
day = "1",
doi = "10.1016/j.athoracsur.2017.11.079",
language = "English",
volume = "105",
pages = "1717--1723",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "The Society of Thoracic Surgeons. Published by Elsevier Inc",
number = "6",

}

TY - JOUR

T1 - Early Outcome of Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly

AU - Rubino, Antonino S.

AU - Gatti, Giuseppe

AU - Reichart, Daniel

AU - Tauriainen, Tuomas

AU - De Feo, Marisa

AU - Onorati, Francesco

AU - Pappalardo, Aniello

AU - Chocron, Sidney

AU - Gulbins, Helmut

AU - Dalén, Magnus

AU - Svenarud, Peter

AU - Faggian, Giuseppe

AU - Franzese, Ilaria

AU - Santarpino, Giuseppe

AU - Fischlein, Theodor

AU - Maselli, Daniele

AU - Nardella, Saverio

AU - Gherli, Riccardo

AU - Ahmed, Aamer

AU - Santini, Francesco

AU - Salsano, Antonio

AU - Nicolini, Francesco

AU - Zanobini, Marco

AU - Saccocci, Matteo

AU - Ruggieri, Vito G.

AU - Bounader, Karl

AU - Mignosa, Carmelo

AU - D'Errigo, Paola

AU - Rosato, Stefano

AU - Airaksinen, Juhani

AU - Perrotti, Andrea

AU - Biancari, Fausto

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: Bilateral internal mammary artery (BIMA) grafting is increasingly used in elderly patients without evidence of its risks or benefits compared with single internal mammary artery (SIMA) grafting. Methods: In all, 2,899 patients aged 70 years or older (855 [29.5%] underwent BIMA grafting) operated on from January 2015 to December 2016 and included in the prospective multicenter Outcome After Coronary Artery Bypass Grafting (E-CABG) study were considered in this analysis. Results: One-to-one propensity matching resulted in 804 pairs with similar preoperative risk profile. Propensity score matched analysis showed that BIMA grafting was associated with a nonstatistically significant increased risk of inhospital death (2.7% versus 1.6%, p = 0.117). The BIMA grafting cohort had a significantly increased risk of any sternal wound infection (7.7% versus 5.1%, p = 0.031) as well as higher risk of deep sternal wound infection/mediastinitis (4.0% versus 2.2%, p = 0.048). The BIMA grafting cohort required more frequently extracorporeal membrane oxygenation (1.0% versus 0.1%, p = 0.02), and the intensive care unit stay (mean 3.6 versus 2.6 days, p < 0.001) and inhospital stay (mean 11.3 versus 10.0 days, p < 0.001) were significantly longer compared with the SIMA grafting cohort. Test for interaction showed that urgent operation in patients undergoing BIMA grafting was associated with higher risk of inhospital death (5.6% versus 1.3%, p = 0.009). Conclusions: Bilateral internal mammary artery grafting in elderly patients seems to be associated with a worse early outcome compared with SIMA grafting, particularly in patients undergoing urgent operation. Until more conclusive results are gathered, BIMA grafting should be reserved only for elderly patients with stable coronary artery disease, without significant baseline comorbidities and with long life expectancy.

AB - Background: Bilateral internal mammary artery (BIMA) grafting is increasingly used in elderly patients without evidence of its risks or benefits compared with single internal mammary artery (SIMA) grafting. Methods: In all, 2,899 patients aged 70 years or older (855 [29.5%] underwent BIMA grafting) operated on from January 2015 to December 2016 and included in the prospective multicenter Outcome After Coronary Artery Bypass Grafting (E-CABG) study were considered in this analysis. Results: One-to-one propensity matching resulted in 804 pairs with similar preoperative risk profile. Propensity score matched analysis showed that BIMA grafting was associated with a nonstatistically significant increased risk of inhospital death (2.7% versus 1.6%, p = 0.117). The BIMA grafting cohort had a significantly increased risk of any sternal wound infection (7.7% versus 5.1%, p = 0.031) as well as higher risk of deep sternal wound infection/mediastinitis (4.0% versus 2.2%, p = 0.048). The BIMA grafting cohort required more frequently extracorporeal membrane oxygenation (1.0% versus 0.1%, p = 0.02), and the intensive care unit stay (mean 3.6 versus 2.6 days, p < 0.001) and inhospital stay (mean 11.3 versus 10.0 days, p < 0.001) were significantly longer compared with the SIMA grafting cohort. Test for interaction showed that urgent operation in patients undergoing BIMA grafting was associated with higher risk of inhospital death (5.6% versus 1.3%, p = 0.009). Conclusions: Bilateral internal mammary artery grafting in elderly patients seems to be associated with a worse early outcome compared with SIMA grafting, particularly in patients undergoing urgent operation. Until more conclusive results are gathered, BIMA grafting should be reserved only for elderly patients with stable coronary artery disease, without significant baseline comorbidities and with long life expectancy.

UR - http://www.scopus.com/inward/record.url?scp=85046737454&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046737454&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2017.11.079

DO - 10.1016/j.athoracsur.2017.11.079

M3 - Article

AN - SCOPUS:85046737454

VL - 105

SP - 1717

EP - 1723

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 6

ER -