Skeletonized vs Pedicled Internal Mammary Artery Graft Harvesting in Coronary Artery Bypass Surgery: A Post Hoc Analysis From the COMPASS Trial
Jazyk angličtina Země Spojené státy americké Médium print
Typ dokumentu časopisecké články, multicentrická studie, randomizované kontrolované studie
PubMed
34132753
PubMed Central
PMC8209583
DOI
10.1001/jamacardio.2021.1686
PII: 2780714
Knihovny.cz E-zdroje
- MeSH
- koronární bypass metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mamární tepny * transplantace MeSH
- nemoci koronárních tepen * etiologie chirurgie MeSH
- průchodnost cév MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
IMPORTANCE: The relative safety and patency of skeletonized vs pedicled internal mammary artery grafts in patients undergoing coronary artery bypass graft (CABG) surgery are unknown. OBJECTIVE: To investigate the association of skeletonized vs pedicled harvesting with internal mammary artery graft patency and clinical outcomes 1 year after CABG surgery. DESIGN, SETTING, AND PARTICIPANTS: This study was a post hoc analysis of the multicenter, randomized, double-blind, placebo-controlled Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) clinical trial, which enrolled 27 395 patients from 602 centers in 33 countries from March 2013 through May 2016. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 grafts implanted and an estimated glomerular filtration rate of at least 30 mL/min. A total of 1002 of 1448 patients were randomized to the CABG arm of the COMPASS trial and underwent skeletonized (282 [28.1%]) or pedicled (720 [71.9%]) internal mammary artery harvesting. The patients had evaluable angiography results 1 year after surgery. Data were analyzed from October 11, 2019, to May 14, 2020. INTERVENTIONS: Patients underwent graft harvesting with either the pedicled technique or skeletonized technique. MAIN OUTCOMES AND MEASURES: The primary outcome was graft occlusion 1 year after CABG surgery, as assessed by computed tomography angiography. RESULTS: A total of 1002 patients underwent skeletonized (282 [28.1%]; mean [SD] age, 65.9 [8.1] years; 229 men [81.2%]; 194 White patients [68.8%]) or pedicled (720 [71.9%]; mean [SD] age, 64.8 [7.6] years; 603 men [83.8%]; 455 White patients [63.2%]) internal mammary artery harvesting. Rates of internal mammary artery graft occlusion 1 year after CABG surgery were higher in the skeletonized group than in the pedicled group (33 of 344 [9.6%] vs 30 of 764 [3.9%]; graft-level adjusted odds ratio, 2.41; 95% CI, 1.39-4.20; P = .002), including the left internal mammary artery to left anterior descending artery (21 of 289 [7.3%] vs 25 of 725 [3.4%]; graft-level adjusted odds ratio, 2.10; 95% CI, 1.14-3.88, P = .02). After a mean follow-up of 23 months, skeletonized graft harvesting was also associated with a higher rate of major adverse cardiovascular events (20 [7.1%] vs 15 [2.1%]; adjusted hazard ratio, 3.19; 95% CI, 1.53-6.67; P = .002) and repeated revascularization (14 [5.0%] vs 10 [1.4%]; adjusted hazard ratio, 2.75; 95% CI, 1.10-6.88; P = .03). CONCLUSIONS AND RELEVANCE: This post hoc analysis of the COMPASS randomized clinical trial found that harvesting of the internal mammary artery during CABG surgery using a skeletonized technique was associated with a higher rate of graft occlusion and worse clinical outcomes than the traditional pedicled technique. Future randomized clinical trials are needed to establish the safety and patency of the skeletonized technique. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01776424.
Department of Cardiac Surgery Centre Hospitalier de l'Universite de Montreal Montreal Quebec Canada
Department of Cardiovascular Surgery Fuwai Hospital Beijing China
Department of Medicine McMaster University Hamilton Ontario Canada
Department of Surgery McMaster University Hamilton Ontario Canada
Department of Thoracic and Cardiovascular Surgery Cleveland Clinic Cleveland Ohio
Population Health Research Institute Hamilton Health Sciences Hamilton Ontario Canada
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Yusuf S, Zucker D, Peduzzi P, et al. . Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994;344(8922):563-570. doi:10.1016/S0140-6736(94)91963-1 PubMed DOI
Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol. 1996;28(3):616-626. doi:10.1016/0735-1097(96)00206-9 PubMed DOI
Goldman S, Zadina K, Moritz T, et al. ; VA Cooperative Study Group #207/297/364 . Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol. 2004;44(11):2149-2156. doi:10.1016/j.jacc.2004.08.064 PubMed DOI
Taggart DP, Benedetto U, Gerry S, et al. ; Arterial Revascularization Trial Investigators . Bilateral versus single internal-thoracic-artery grafts at 10 years. N Engl J Med. 2019;380(5):437-446. doi:10.1056/NEJMoa1808783 PubMed DOI
Taggart DP, Lees B, Gray A, Altman DG, Flather M, Channon K; ART Investigators . Protocol for the Arterial Revascularisation Trial (ART): a randomised trial to compare survival following bilateral versus single internal mammary grafting in coronary revascularisation [ISRCTN46552265]. Trials. 2006;7(1):7. doi:10.1186/1745-6215-7-7 PubMed DOI PMC
Gaudino M, Alexander JH, Bakaeen FG, et al. . Randomized comparison of the clinical outcome of single versus multiple arterial grafts: the ROMA trial-rationale and study protocol. Eur J Cardiothorac Surg. 2017;52(6):1031-1040. doi:10.1093/ejcts/ezx358 PubMed DOI
Bosch J, Eikelboom JW, Connolly SJ, et al. . Rationale, design and baseline characteristics of participants in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial. Can J Cardiol. 2017;33(8):1027-1035. doi:10.1016/j.cjca.2017.06.001 PubMed DOI
Eikelboom JW, Connolly SJ, Bosch J, et al. ; COMPASS Investigators . Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017;377(14):1319-1330. doi:10.1056/NEJMoa1709118 PubMed DOI
Lamy A, Eikelboom J, Sheth T, et al. . Rivaroxaban, aspirin, or both to prevent early coronary bypass graft occlusion: the COMPASS-CABG Study. J Am Coll Cardiol. 2019;73(2):121-130. doi:10.1016/j.jacc.2018.10.048 PubMed DOI
FitzGibbon GM, Burton JR, Leach AJ. Coronary bypass graft fate: angiographic grading of 1400 consecutive grafts early after operation and of 1132 after one year. Circulation. 1978;57(6):1070-1074. doi:10.1161/01.CIR.57.6.1070 PubMed DOI
Sun X, Huang J, Wang W, et al. . Off-pump skeletonized versus pedicled left internal mammary artery grafting: mid-term results. J Card Surg. 2015;30(6):494-499. doi:10.1111/jocs.12551 PubMed DOI
Mannacio V, Di Tommaso L, De Amicis V, Stassano P, Vosa C. Randomized flow capacity comparison of skeletonized and pedicled left internal mammary artery. Ann Thorac Surg. 2011;91(1):24-30. doi:10.1016/j.athoracsur.2010.06.131 PubMed DOI
Benedetto U, Altman DG, Gerry S, et al. ; Arterial Revascularization Trial investigators . Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: insights from the Arterial Revascularization Trial. J Thorac Cardiovasc Surg. 2016;152(1):270-276. doi:10.1016/j.jtcvs.2016.03.056 PubMed DOI
Sá MP, Ferraz PE, Escobar RR, et al. . Skeletonized versus pedicled internal thoracic artery and risk of sternal wound infection after coronary bypass surgery: meta-analysis and meta-regression of 4817 patients. Interact Cardiovasc Thorac Surg. 2013;16(6):849-857. doi:10.1093/icvts/ivt012 PubMed DOI PMC
Amano A, Takahashi A, Hirose H. Skeletonized radial artery grafting: improved angiographic results. Ann Thorac Surg. 2002;73(6):1880-1887. doi:10.1016/S0003-4975(02)03559-2 PubMed DOI
Calafiore AM, Vitolla G, Iaco AL, et al. . Bilateral internal mammary artery grafting: midterm results of pedicled versus skeletonized conduits. Ann Thorac Surg. 1999;67(6):1637-1642. doi:10.1016/S0003-4975(99)00282-9 PubMed DOI
Hirose H, Amano A, Takanashi S, Takahashi A. Skeletonized bilateral internal mammary artery grafting for patients with diabetes. Interact Cardiovasc Thorac Surg. 2003;2(3):287-292. doi:10.1016/S1569-9293(03)00046-X PubMed DOI
Kai M, Hanyu M, Soga Y, et al. . Off-pump coronary artery bypass grafting with skeletonized bilateral internal thoracic arteries in insulin-dependent diabetics. Ann Thorac Surg. 2007;84(1):32-36. doi:10.1016/j.athoracsur.2007.02.095 PubMed DOI
Sazzad MF, Moniruzzaman M, Chanda PK, et al. . Short term clinical and angiographic outcome of skeletonized harvesting technique of left internal mammary artery, compared to pedicled harvesting for coronary revascularization. University Heart Journal. 2016;12(2):82-87. doi:10.3329/uhj.v12i2.36388 DOI
Sá MP, Ferraz PE, Escobar RR, et al. . Patency of skeletonized versus pedicled internal thoracic artery in coronary bypass graft surgery: a systematic review, meta-analysis and meta-regression. Int J Surg. 2014;12(7):666-672. doi:10.1016/j.ijsu.2014.05.071 PubMed DOI
Taggart DP, Altman DG, Gray AM, et al. ; ART Investigators . Randomized trial of bilateral versus single internal-thoracic-artery grafts. N Engl J Med. 2016;375(26):2540-2549. doi:10.1056/NEJMoa1610021 PubMed DOI
Harskamp RE, Alexander JH, Ferguson TB Jr, et al. . Frequency and predictors of internal mammary artery graft failure and subsequent clinical outcomes: insights from the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial. Circulation. 2016;133(2):131-138. doi:10.1161/CIRCULATIONAHA.115.015549 PubMed DOI PMC
Alexander JH, Hafley G, Harrington RA, et al. ; PREVENT IV Investigators . Efficacy and safety of edifoligide, an E2F transcription factor decoy, for prevention of vein graft failure following coronary artery bypass graft surgery: PREVENT IV: a randomized controlled trial. JAMA. 2005;294(19):2446-2454. doi:10.1001/jama.294.19.2446 PubMed DOI
Lopes RD, Hafley GE, Allen KB, et al. . Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery. N Engl J Med. 2009;361(3):235-244. doi:10.1056/NEJMoa0900708 PubMed DOI
Shroyer AL, Grover FL, Hattler B, et al. ; Veterans Affairs Randomized On/Off Bypass (ROOBY) Study Group . On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med. 2009;361(19):1827-1837. doi:10.1056/NEJMoa0902905 PubMed DOI
Houlind K, Fenger-Grøn M, Holme SJ, et al. . Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: results from the Danish On-pump Versus Off-pump Randomization Study (DOORS). J Thorac Cardiovasc Surg .2014;148(5):1812-1819.e2. doi:10.1016/j.jtcvs.2014.02.024 PubMed DOI
Zhao Q, Zhu Y, Xu Z, et al. . Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on saphenous vein graft patency 1 year after coronary artery bypass grafting: a randomized clinical trial. JAMA. 2018;319(16):1677-1686. doi:10.1001/jama.2018.3197 PubMed DOI PMC
ClinicalTrials.gov
NCT01776424
