RESUMO
BACKGROUND: The internal thoracic artery (ITA) bypass to the left anterior descending coronary artery is of proven benefit in multigraft coronary artery bypass. Total ITA grafts, if reoperation is averted by avoiding saphenous vein grafts (SVGs), are attractive. The safety of the total ITA graft operation (all-ITA) is a concern. METHODS: A randomized trial of multiple-ITA bypass graftings with the use of bilateral sequential ITA without SVGs was performed. Control patients received 1 ITA plus SVG. Inclusion criteria were those used in the Coronary Artery Surgery Study, extended to age 76 years, and any angina class, except emergent. One hundred sixty-two patients were randomized (81 patients per group) from January 1, 1990, to December 31, 1994. RESULTS: Baseline traits were similar as were cross-clamp times, pump times, and number of arteries bypassed (average, 4.3 arteries). Patients who received multiple ITA grafts had no myocardial infarctions, per reference laboratory. One patient died, and 2 patients returned for bleeding. The ITA-SVG group had similar results. The all-ITA group experienced successful completion in 93% of cases. Complications did not differ from control patients. CONCLUSIONS: Early and 5-year outcomes were not different between the all-ITA group and the ITA with SVGs group. We believe experienced surgeons can safely extend the ITA to multibypass coronary artery bypass without use of SVG to achieve an all-ITA operation.
Assuntos
Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/estatística & dados numéricos , Doença das Coronárias/mortalidade , Doença das Coronárias/cirurgia , Artéria Torácica Interna/cirurgia , Idoso , Circulação Coronária , Doença das Coronárias/diagnóstico , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Complicações Pós-Operatórias/mortalidade , Artéria Radial , Veia Safena , Análise de Sobrevida , Resultado do TratamentoAssuntos
Tempo de Internação/legislação & jurisprudência , Programas de Assistência Gerenciada/legislação & jurisprudência , Defesa do Paciente/legislação & jurisprudência , Assistência Perinatal/economia , Assistência Perinatal/legislação & jurisprudência , Papel do Médico , Feminino , Humanos , Recém-Nascido , Gravidez , Estados Unidos , WisconsinAssuntos
Ética Médica , Defesa do Paciente/legislação & jurisprudência , Aborto Legal , Feminino , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Masculino , Programas de Assistência Gerenciada/legislação & jurisprudência , Gravidez , Suicídio Assistido/legislação & jurisprudência , WisconsinRESUMO
Two-hundred and nine male patients who had coronary artery surgery from 1972 to 1974 at the Marshfield Clinic (MC) were compared with Veterans Administration (VA) coronary patients to determine the probability of coronary surgery prolonging life. The survival data includes operative and late cardiac and noncardiac deaths. Including the MC operative mortality rates but considering late noncardiac deaths withdrawn as alive at the time of death, the MC cumulative 5-year surgical survival rate is 93%. This is identical to predicted 93% 5-year survival rate for any man of 54.5 years, the average age of MC patients living in this geographic locale in 1973. Annual attrition rates, including the noncardiac deaths, are 1.4% for any man 1.5% per year for MC patients, based on MC 5-year survival data. It is probable that coronary surgery prolongs life by sharply reducing late cardiac deaths.
