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dc.contributor.authorBuxton, Brian Fen
dc.contributor.authorShi, William Yen
dc.contributor.authorTatoulis, Jamesen
dc.contributor.authorFuller, John Aen
dc.contributor.authorRosalion, Alexanderen
dc.contributor.authorHayward, Philip A Ren
dc.identifier.citationThe Journal of Thoracic and Cardiovascular Surgery 2014; 148(4): 1238-43; discussion 1243-4en
dc.description.abstractWe sought to evaluate our experience with total arterial revascularization and compare it with the traditional approach of a single internal thoracic artery supplemented by saphenous veins.From 1995 to 2010, 6059 patients with triple-vessel coronary artery disease underwent primary isolated coronary artery bypass grafting at 8 centers. A study cohort of 3774 patients was formed, with 2988 (79%) undergoing total arterial revascularization and 786 (21%) receiving only saphenous veins to supplement a single in situ internal thoracic artery. In the total arterial revascularization group, bilateral internal thoracic arteries were used in 1079 patients (36%) and at least 1 radial artery was used in 2916 patients (97%). Propensity score matching was used for risk adjustment.Patients undergoing total arterial revascularization were younger (65.0±10.4 years vs 71.3±7.9 years, P<.001) and less likely to have diabetes, cerebrovascular disease, recent myocardial infarction, and severe left ventricular impairment. At 15 years, patients who underwent total arterial revascularization experienced superior unadjusted survival (62%±1.1% vs 35%±1.9%, P<.001). Multivariable Cox regression in the entire study cohort showed the total arterial group had improved survival with a hazard ratio of 0.79 (95% confidence interval, 0.70-0.90; P<.001). After propensity score matching yielded 384 patient pairs, patients who underwent total arterial revascularization showed improved survival at 15 years than patients who underwent single arterial revascularization (54%±3.3% vs 41%±3.0%, P=.0004).This large multicenter study suggests that a strategy of total arterial revascularization is associated with improved long-term survival compared with the use of only a single arterial and saphenous vein grafts. Total arterial revascularization should be encouraged in patients with a reasonable life expectancy.en
dc.subject.otherAged, 80 and overen
dc.subject.otherCoronary Artery Bypassen
dc.subject.otherCoronary Artery Disease.mortality.surgeryen
dc.subject.otherHospital Mortalityen
dc.subject.otherInternal Mammary-Coronary Artery Anastomosis.methods.mortalityen
dc.subject.otherMammary Arteries.transplantationen
dc.subject.otherMiddle Ageden
dc.subject.otherMyocardial Revascularization.methods.mortalityen
dc.subject.otherPropensity Scoreen
dc.subject.otherRadial Artery.transplantationen
dc.subject.otherRisk Factorsen
dc.titleTotal arterial revascularization with internal thoracic and radial artery grafts in triple-vessel coronary artery disease is associated with improved survival.en
dc.typeJournal Articleen
dc.identifier.journaltitleThe Journal of thoracic and cardiovascular surgeryen
dc.identifier.affiliationVictorian Heart Centre, Epworth Hospital, University of Melbourne, Melbourne, Australiaen
dc.identifier.affiliationDepartment of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australiaen
dc.identifier.affiliationDepartment of Cardiac Surgery, Austin Hospital, University of Melbourne, Melbourne, Australiaen
dc.description.pages1238-43; discussion 1243-4en
dc.type.austinJournal Articleen
item.fulltextNo Fulltext-
item.openairetypeJournal Article- Surgery-
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