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ABSTRACT: : The use of bilateral internal thoracic arteries (BITAs) during coronary artery bypass grafting (CABG) improves long-term and event-free survival compared with single internal thoracic artery (SITA) grafting. It is controversial whether BITA grafting alters in-hospital adverse events after CABG.
: Isolated CABG cases using BITA or SITA at a single US academic center between January 1, 1997 and June 30, 2006 were retrospectively reviewed. A propensity score was used as a covariate to balance the treatment groups (BITA and SITA) with respect to 44 preoperative risk factors. A multivariable logistic regression model tested whether treatment type was significantly associated with in-hospital death, deep sternal wound infection (DSWI), or hospital length of stay (LOS).
: There were 599 BITA and 10,212 SITA cases performed. Overall for all BITA versus SITA cases, adjusted mortality (0.8% vs. 1.7%, P = 0.85) was not different between the groups. However, adjusted incidence of DSWI (2.0% vs. 1.2%, P = 0.036) and LOS (6.7 vs. 6.1, P = 0.025) were significantly higher in BITA patients. Subsets analyses of obese patients and diabetic patients revealed no statistical differences for any of the outcomes between BITA and SITA.
: The long-term benefits of BITA grafting do not come at the cost of increased adjusted risk of in-hospital death. BITA grafting was associated with an increased risk of DSWI and a longer adjusted LOS. Neither obesity, nor diabetes significantly increased the risk of poor outcomes after BITA.
Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 01/2008; 3(1):19-24.
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ABSTRACT: Women experience greater morbidity and mortality than men after conventional coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB). The objective of this study was to determine whether off-pump CABG (OPCAB) alters this gender-based disparity.
Retrospective review of risk factors and clinical outcomes for 11 413 consecutive patients having isolated CABG between January 1, 1997, and May 31, 2005, at a US academic center. Interventions were OPCAB or CABG/CPB, performed at the discretion of 14 faculty surgeons. Main outcome measures included in-hospital death, stroke, myocardial infarction or combined major adverse cardiac events (MACE = death or stroke or myocardial infarction). Odds ratios of adverse events, adjusted for 31 risk factors, were compared between women and men who had OPCAB versus CABG/CPB. Covariates included Propensity Score, Society of Thoracic Surgeons' Predicted Risk, surgeon and body habitus. Female patients (n=3248) and those treated with OPCAB (n=4492) were older, had more comorbidities and higher predicted risk than male patients (n=8165) and those treated with conventional CABG/CPB (n=6921), respectively. Women treated with CABG/CPB had a risk-adjusted odds ratio of 1.60 for death (P=0.01), 1.71 for stroke (P=0.007), 2.26 for myocardial infarction (P=0.008) and 1.71 for MACE (P<0.001) compared with men who had CABG/CPB. In contrast, women treated with OPCAB had outcomes statistically similar to men who had either OPCAB or CABG/CPB. Among women, OPCAB was associated with a significant reduction in death (OR 0.39, P=0.001), stroke (OR 0.43, P=0.002) and MACE (OR 0.43, P<0.001).
OPCAB is associated with fewer major adverse cardiac events and benefits women disproportionately, thereby narrowing the gender disparity in clinical outcomes after CABG.
Circulation 09/2007; 116(11 Suppl):I192-9. · 14.74 Impact Factor
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ABSTRACT: Coronary artery disease (CAD) is the most common cause of heart failure in Western countries. Selected patients who have low left ventricular ejection fraction (LVEF) and CAD clearly benefit from coronary revascularization with coronary artery bypass grafting (CABG). CABG results seem to be superior to percutaneous coronary intervention (PCI) in the few comparative studies of the two approaches in patients who have CAD and low LVEF completed to date. Clinical improvement should be expected in most patients who undergo CABG. This is important for patients who have a limited life span that they could spend with a good functional status rather than being hospitalized for multiple repeat PCIs or symptomatic deterioration.
Heart Failure Clinics 05/2007; 3(2):211-28.
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ABSTRACT: : Application of off-pump techniques to reoperative coronary artery bypass (redo CABG) has been limited by technical difficulty and potential for embolism of atheromatous debris from diseased grafts, resulting in myocardial infarction and rapid hemodynamic deterioration. We compared outcomes after off-pump (OPCAB) and on-pump (ONCAB) in redo CABG.
: A retrospective chart review was performed for patients who underwent redo CABG at a single academic institution between January 1997 and December 2004. Outcomes were compared between groups based on intention to treat. Propensity scores were calculated for each patient using 23 preoperative risk factors. Logistic regression was applied for each end point as a function of group and propensity score.
: A total of 771 consecutive patients had redo CABG (639 ONCAB and 132 OPCAB); 22 patients (16.7%) were converted from OPCAB to ONCAB for hemodynamic in stability, severe adhesions, or graft injury; 7 patients (1.1%) were converted from ONCAB to OPCAB for severe aortic calcification. Propensity-matched comparison of outcomes after OPCAB versus ONCAB for redo CABG showed that OPCAB was associated with a reduction in postoperative complications, transfusion, atrial fibrillation, and length of stay. OPCAB patients received fewer grafts with similar use of left internal mammary artery conduit; conversion from OPCAB to ONCAB did not reduce the benefit of OPCAB.
: OPCAB can be safely and effectively applied to reoperative CABG in selected cases.
Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 01/2007; 2(1):29-32.
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ABSTRACT: To investigate the incidence of neoaortic insufficiency in patients with hypoplastic left heart syndrome treated with the Norwood-Sano palliation and to compare it with that occurring after the classic Norwood procedure. DESIGN, SETTING, PATIENTS, INTERVENTIONS: This was a retrospective review of all echocardiograms of patients diagnosed with hypoplastic left heart syndrome (concomitant presence of left ventricular and aortic and mitral severe hypoplasia or atresia) who underwent staged palliation of the Norwood or Norwood-Sano type at a single academic institution between September 1999 and February 2005 and who survived a minimum of 3 months.
Neoaortic insufficiency was categorized as absent or mild <1 mm jet width, moderate 1-3 mm jet width, or severe >3 mm jet width. The patients were grouped according to initial palliation, that is, classic Norwood and Norwood-Sano operation.
Fifty-nine consecutive patients (median age of 20 months with a range from 3 to 66 months) satisfied inclusion criteria. Neoaortic insufficiency was absent or mild in 55 of 59 (93.22%) of the patients. There were 4 cases of significant neoaortic insufficiency at late follow-up: 2 moderate following the classic Norwood and 1 moderate and 1 severe following the Norwood-Sano procedure, one of whom required valve replacement.
In this series of patients with hypoplastic left heart syndrome, the Sano modification was not associated with an increased incidence of significant neoaortic insufficiency. When present, moderate/severe neoaortic insufficiency appeared late after initial palliation and was associated with recurrent ascending aortic or aortic arch pathology in every case.
Congenital Heart Disease 12/2006; 1(6):289-93. · 0.90 Impact Factor
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ABSTRACT: Ventricular aneurysms in the pediatric population are rare and no standardized method of treatment exists. We present a case of left ventricular (LV) aneurysm in an infant, 5 weeks after a balloon aortic valvuloplasty for congenital aortic stenosis.
Echocardiography 05/2006; 23(4):329-31. · 1.24 Impact Factor
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The Annals of Thoracic Surgery 03/2004; 77(2):724. · 3.74 Impact Factor
