Please use this identifier to cite or link to this item: http://hdl.handle.net/11434/472
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dc.contributor.authorBuxton, Brian-
dc.contributor.authorTatoulis, James-
dc.contributor.authorFuller, John-
dc.contributor.authorRosalion, Alexander-
dc.contributor.authorHayward, Philip-
dc.contributor.otherShi, William-
dc.date2014-07-
dc.date.accessioned2015-11-20T02:58:52Z-
dc.date.available2015-11-20T02:58:52Z-
dc.date.issued2014-10-
dc.identifier.citationJournal of Thoracic and Cardiovascular Surgery 2014 Oct;148(4):1238-43; discussion 1243-4en_US
dc.identifier.issn0022-5223en_US
dc.identifier.urihttp://hdl.handle.net/11434/472-
dc.description.abstractOBJECTIVES: We 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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_US
dc.publisherElsevieren_US
dc.subjectVictorian Heart Centre, Epworth Hospital, Richmond, Victoria, Australiaen_US
dc.subjectCoronary Artery Diseaseen_US
dc.subjectGraftsen_US
dc.subjectSurvivalen_US
dc.subjectInternal Thoracic Arteryen_US
dc.subjectSaphenous Veinen_US
dc.subjectCoronary Artery Bypass Graftingen_US
dc.subjectCoronary Artery Bypass Surgeryen_US
dc.subjectBypass Surgery, Coronary Arteryen_US
dc.subjectBypass, Coronary Arteryen_US
dc.subjectTotal Arterial Revascularisationen_US
dc.subjectTARen_US
dc.titleTotal arterial revascularization with internal thoracic and radial artery grafts in triple-vessel coronary artery disease is associated with improved survival.en_US
dc.typeJournal Articleen_US
dc.identifier.doi10.1016/j.jtcvs.2014.06.056.en_US
dc.identifier.journaltitleJournal of Thoracic and Cardiovascular Surgeryen_US
dc.description.pubmedurihttp://www.ncbi.nlm.nih.gov/pubmed/25131165en_US
dc.description.affiliatesUniversity of Melbourne, Melbourne, Victoria, Australiaen_US
dc.description.affiliatesDepartment of Cardiac Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australiaen_US
dc.description.affiliatesDepartment of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australiaen_US
dc.type.studyortrialMulticentre Studiesen_US
dc.type.contenttypeTexten_US
Appears in Collections:Cardiac Sciences

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