Pedicled versus skeletonized internal thoracic artery grafts: a randomized trial

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Dreifaldt, Mats,1959-Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Cardiovascular and Thoracic Surgery (author)

Pedicled versus skeletonized internal thoracic artery grafts : a randomized trial

Article/chapterEnglish2021

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2020-12-17
Medikaru Toribyun,2021
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LIBRIS-ID:oai:DiVA.org:oru-88165
https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-88165URI
https://doi.org/10.1177/0218492320983491DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:233334128URI

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Language:English
Summary in:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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Funding Agency:Nyckelfonden OLL-506851
OBJECTIVE: Concerns have been raised regarding whether skeletonization of the internal thoracic artery could damage the graft and thereby reduces its patency. The objective of this study was to compare patency rates at mid- and long-term follow-up between pedicled and skeletonized left internal thoracic artery grafts.METHODS: This randomized controlled trial included 109 patients undergoing coronary artery bypass surgery. The patients were assigned to receive either one pedicled or one skeletonized left internal thoracic artery graft to the left anterior descending artery. Follow-up was performed at 3 years with conventional angiography, and at 8 years with computed tomography angiography. Differences between patency rates were analyzed with Fisher's exact test and a generalized linear model.RESULTS: The patency rates for pedicled and skeletonized left internal thoracic artery grafts were 46/48 (95.8%) versus 47/52 (90.4%), p = 0.44 at 3 years, and 40/43 (93.0%) versus 37/41 (90.2%), p = 0.71 at 8 years, respectively. The difference in patency rates for pedicled and skeletonized grafts was 5.4% (95% confidence interval: -4.2-14.5) at 3 years and 2.8% (95% confidence interval: -9.9-14.1) at 8 years. All failed grafts, except for one with a localized stenosis, were anastomosed to native coronary arteries with a stenosis less than 70%. Three patients suffered sternal wound infections (two in the pedicled group, one in the skeletonized group).CONCLUSIONS: The skeletonization technique can be used without jeopardizing the patency of the left internal thoracic artery. The most important factor in graft failure was target artery stenosis below 70%.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
Coronary artery bypass
graft occlusion
saphenous vein
thoracic arteries
tissue

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Samano, Ninos,1972-Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center(Swepub:oru)nso (author)
Geijer, Håkan,1961-Örebro universitet,Institutionen för medicinska vetenskaper,Department of Radiology(Swepub:oru)hngr (author)
Lidén, Mats,1976-Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Radiology(Swepub:oru)msld (author)
Bodin, LennartKarolinska Institutet (author)
de Souza, Domingos Ramos,1954-Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Cardiovascular and Thoracic Surgery(Swepub:oru)dra (author)
Örebro universitetInstitutionen för medicinska vetenskaper (creator_code:org_t)

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In:Asian cardiovascular & thoracic annals: Medikaru Toribyun29:6, s. 490-4971816-53700218-4923

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