Bilateral Internal Thoracic Artery Grafting Increases Mediastinitis: Myth or Fact?
Background There is controversy about the risk of mediastinitis associated with the use of both internal thoracic arteries (ITA). Methods We performed a case-control study of patients operated on at a single institution from January 2003 to December 2014. A total of 3,118 consecutive patients underg...
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Veröffentlicht in: | The Annals of thoracic surgery 2017-03, Vol.103 (3), p.834-839 |
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creator | Vrancic, Juan M., MD Piccinini, Fernando, MD Camporrotondo, Mariano, MD Espinoza, Juan C., MD Camou, Juan I., MD Nacinovich, Francisco, MD Oses, Pablo Fernandez, MD Navia, Daniel, MD |
description | Background There is controversy about the risk of mediastinitis associated with the use of both internal thoracic arteries (ITA). Methods We performed a case-control study of patients operated on at a single institution from January 2003 to December 2014. A total of 3,118 consecutive patients undergoing isolated coronary artery bypass graft surgery were included; 81.3% (n = 2,533) underwent bilateral ITA (BITA) grafts exclusively and constitute the BITA group, and 18.7% (n = 585) constitute the single ITA (SITA) group. Mediastinitis was defined as deep tissue mediastinal infection, with clinical or microbiologic evidence. Continuous variables were expressed as mean ± standard deviation, and categoric variables as percentage (range). Student’s t test and Fisher’s exact test were used, as appropriate. Propensity score matching analysis was performed according to the nearest neighbor estimation method (n = 1,040). Results The incidence of diabetes mellitus was similar in both groups (29%, p = 0.9). The BITA patients were more like to be younger ( p < 0.001), men ( p < 0.001), had a higher prevalence of hypertension ( p < 0.01), higher body mass index ( p < 0.001), lower prevalence of left ventricular dysfunction ( p < 0.001) and of previous myocardial infarction ( p < 0.01), and greater use of off-pump coronary artery bypass graft surgery ( p < 0.01). The BITA patients had lower unadjusted hospital mortality (1.6%, versus 5.3% for SITA, p < 0.0001). The total incidence of mediastinitis was 1.8% (BITA 1.9% versus SITA 1.5%, p = 0.6). Diabetes ( p < 0.01) and nonelective surgery ( p = 0.004) were the only predictors of mediastinitis in the entire population. Propensity score matching showed no differences in mediastinitis: BITA 2.5% versus SITA 1.3% ( p = 0.17). Conclusions In this series of patients, BITA did not increase the risk of mediastinitis in the total population or in the propensity score matched subgroups. |
doi_str_mv | 10.1016/j.athoracsur.2016.06.080 |
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Methods We performed a case-control study of patients operated on at a single institution from January 2003 to December 2014. A total of 3,118 consecutive patients undergoing isolated coronary artery bypass graft surgery were included; 81.3% (n = 2,533) underwent bilateral ITA (BITA) grafts exclusively and constitute the BITA group, and 18.7% (n = 585) constitute the single ITA (SITA) group. Mediastinitis was defined as deep tissue mediastinal infection, with clinical or microbiologic evidence. Continuous variables were expressed as mean ± standard deviation, and categoric variables as percentage (range). Student’s t test and Fisher’s exact test were used, as appropriate. Propensity score matching analysis was performed according to the nearest neighbor estimation method (n = 1,040). Results The incidence of diabetes mellitus was similar in both groups (29%, p = 0.9). The BITA patients were more like to be younger ( p < 0.001), men ( p < 0.001), had a higher prevalence of hypertension ( p < 0.01), higher body mass index ( p < 0.001), lower prevalence of left ventricular dysfunction ( p < 0.001) and of previous myocardial infarction ( p < 0.01), and greater use of off-pump coronary artery bypass graft surgery ( p < 0.01). The BITA patients had lower unadjusted hospital mortality (1.6%, versus 5.3% for SITA, p < 0.0001). The total incidence of mediastinitis was 1.8% (BITA 1.9% versus SITA 1.5%, p = 0.6). Diabetes ( p < 0.01) and nonelective surgery ( p = 0.004) were the only predictors of mediastinitis in the entire population. Propensity score matching showed no differences in mediastinitis: BITA 2.5% versus SITA 1.3% ( p = 0.17). Conclusions In this series of patients, BITA did not increase the risk of mediastinitis in the total population or in the propensity score matched subgroups.]]></description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2016.06.080</identifier><identifier>PMID: 27659597</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Aged ; Cardiothoracic Surgery ; Case-Control Studies ; Female ; Humans ; Internal Mammary-Coronary Artery Anastomosis - adverse effects ; Male ; Mediastinitis - etiology ; Middle Aged ; Surgery</subject><ispartof>The Annals of thoracic surgery, 2017-03, Vol.103 (3), p.834-839</ispartof><rights>The Society of Thoracic Surgeons</rights><rights>2017 The Society of Thoracic Surgeons</rights><rights>Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c545t-d1b0e384efa9d403a4f49068fd4d5fd4f80e8878bb43d2a7331cf1fd5e9e2f833</citedby><cites>FETCH-LOGICAL-c545t-d1b0e384efa9d403a4f49068fd4d5fd4f80e8878bb43d2a7331cf1fd5e9e2f833</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27659597$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vrancic, Juan M., MD</creatorcontrib><creatorcontrib>Piccinini, Fernando, MD</creatorcontrib><creatorcontrib>Camporrotondo, Mariano, MD</creatorcontrib><creatorcontrib>Espinoza, Juan C., MD</creatorcontrib><creatorcontrib>Camou, Juan I., MD</creatorcontrib><creatorcontrib>Nacinovich, Francisco, MD</creatorcontrib><creatorcontrib>Oses, Pablo Fernandez, MD</creatorcontrib><creatorcontrib>Navia, Daniel, MD</creatorcontrib><title>Bilateral Internal Thoracic Artery Grafting Increases Mediastinitis: Myth or Fact?</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description><![CDATA[Background There is controversy about the risk of mediastinitis associated with the use of both internal thoracic arteries (ITA). Methods We performed a case-control study of patients operated on at a single institution from January 2003 to December 2014. A total of 3,118 consecutive patients undergoing isolated coronary artery bypass graft surgery were included; 81.3% (n = 2,533) underwent bilateral ITA (BITA) grafts exclusively and constitute the BITA group, and 18.7% (n = 585) constitute the single ITA (SITA) group. Mediastinitis was defined as deep tissue mediastinal infection, with clinical or microbiologic evidence. Continuous variables were expressed as mean ± standard deviation, and categoric variables as percentage (range). Student’s t test and Fisher’s exact test were used, as appropriate. Propensity score matching analysis was performed according to the nearest neighbor estimation method (n = 1,040). Results The incidence of diabetes mellitus was similar in both groups (29%, p = 0.9). The BITA patients were more like to be younger ( p < 0.001), men ( p < 0.001), had a higher prevalence of hypertension ( p < 0.01), higher body mass index ( p < 0.001), lower prevalence of left ventricular dysfunction ( p < 0.001) and of previous myocardial infarction ( p < 0.01), and greater use of off-pump coronary artery bypass graft surgery ( p < 0.01). The BITA patients had lower unadjusted hospital mortality (1.6%, versus 5.3% for SITA, p < 0.0001). The total incidence of mediastinitis was 1.8% (BITA 1.9% versus SITA 1.5%, p = 0.6). Diabetes ( p < 0.01) and nonelective surgery ( p = 0.004) were the only predictors of mediastinitis in the entire population. Propensity score matching showed no differences in mediastinitis: BITA 2.5% versus SITA 1.3% ( p = 0.17). Conclusions In this series of patients, BITA did not increase the risk of mediastinitis in the total population or in the propensity score matched subgroups.]]></description><subject>Aged</subject><subject>Cardiothoracic Surgery</subject><subject>Case-Control Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Internal Mammary-Coronary Artery Anastomosis - adverse effects</subject><subject>Male</subject><subject>Mediastinitis - etiology</subject><subject>Middle Aged</subject><subject>Surgery</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUU1r3DAQFSWl2ab5C8XHXrzVpy330JKEfEFCoU3OQiuNGm29diLJgf33HXfTBHIqDBrp6c0M7w0hFaNLRlnzeb205W5M1uUpLTkiS4qh6RuyYErxuuGq2yMLSqmoZdeqffI-5zU-OX6_I_u8bVSnunZBfhzH3hZItq8uB8wDXm7-to6uOkqIbKvzZEOJwy9kuAQ2Q66uwUebEYwl5i_V9bbcVWOqzqwr3z6Qt8H2GQ6f8gG5PTu9Obmor76fX54cXdVOSVVqz1YUhJYQbOclFVYG2dFGBy-9wiNoClq3erWSwnPbCsFcYMEr6IAHLcQB-bTre5_GhwlyMZuYHfS9HWCcsmEaFfJOCYVUvaO6NOacIJj7FDc2bQ2jZnbUrM2Lo2Z21FAMTbH049OUabUB_1z4z0IkHO8IgFofIySTXYTBoUMJXDF-jP8z5eurJq5Hc53tf8MW8nqc5s2gJpO5oebnvNl5sawRVEuhxR8YUqI0</recordid><startdate>20170301</startdate><enddate>20170301</enddate><creator>Vrancic, Juan M., MD</creator><creator>Piccinini, Fernando, MD</creator><creator>Camporrotondo, Mariano, MD</creator><creator>Espinoza, Juan C., MD</creator><creator>Camou, Juan I., MD</creator><creator>Nacinovich, Francisco, MD</creator><creator>Oses, Pablo Fernandez, MD</creator><creator>Navia, Daniel, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170301</creationdate><title>Bilateral Internal Thoracic Artery Grafting Increases Mediastinitis: Myth or Fact?</title><author>Vrancic, Juan M., MD ; Piccinini, Fernando, MD ; Camporrotondo, Mariano, MD ; Espinoza, Juan C., MD ; Camou, Juan I., MD ; Nacinovich, Francisco, MD ; Oses, Pablo Fernandez, MD ; Navia, Daniel, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c545t-d1b0e384efa9d403a4f49068fd4d5fd4f80e8878bb43d2a7331cf1fd5e9e2f833</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Cardiothoracic Surgery</topic><topic>Case-Control Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Internal Mammary-Coronary Artery Anastomosis - adverse effects</topic><topic>Male</topic><topic>Mediastinitis - etiology</topic><topic>Middle Aged</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vrancic, Juan M., MD</creatorcontrib><creatorcontrib>Piccinini, Fernando, MD</creatorcontrib><creatorcontrib>Camporrotondo, Mariano, MD</creatorcontrib><creatorcontrib>Espinoza, Juan C., MD</creatorcontrib><creatorcontrib>Camou, Juan I., MD</creatorcontrib><creatorcontrib>Nacinovich, Francisco, MD</creatorcontrib><creatorcontrib>Oses, Pablo Fernandez, MD</creatorcontrib><creatorcontrib>Navia, Daniel, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vrancic, Juan M., MD</au><au>Piccinini, Fernando, MD</au><au>Camporrotondo, Mariano, MD</au><au>Espinoza, Juan C., MD</au><au>Camou, Juan I., MD</au><au>Nacinovich, Francisco, MD</au><au>Oses, Pablo Fernandez, MD</au><au>Navia, Daniel, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bilateral Internal Thoracic Artery Grafting Increases Mediastinitis: Myth or Fact?</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>2017-03-01</date><risdate>2017</risdate><volume>103</volume><issue>3</issue><spage>834</spage><epage>839</epage><pages>834-839</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><abstract><![CDATA[Background There is controversy about the risk of mediastinitis associated with the use of both internal thoracic arteries (ITA). Methods We performed a case-control study of patients operated on at a single institution from January 2003 to December 2014. A total of 3,118 consecutive patients undergoing isolated coronary artery bypass graft surgery were included; 81.3% (n = 2,533) underwent bilateral ITA (BITA) grafts exclusively and constitute the BITA group, and 18.7% (n = 585) constitute the single ITA (SITA) group. Mediastinitis was defined as deep tissue mediastinal infection, with clinical or microbiologic evidence. Continuous variables were expressed as mean ± standard deviation, and categoric variables as percentage (range). Student’s t test and Fisher’s exact test were used, as appropriate. Propensity score matching analysis was performed according to the nearest neighbor estimation method (n = 1,040). Results The incidence of diabetes mellitus was similar in both groups (29%, p = 0.9). The BITA patients were more like to be younger ( p < 0.001), men ( p < 0.001), had a higher prevalence of hypertension ( p < 0.01), higher body mass index ( p < 0.001), lower prevalence of left ventricular dysfunction ( p < 0.001) and of previous myocardial infarction ( p < 0.01), and greater use of off-pump coronary artery bypass graft surgery ( p < 0.01). The BITA patients had lower unadjusted hospital mortality (1.6%, versus 5.3% for SITA, p < 0.0001). The total incidence of mediastinitis was 1.8% (BITA 1.9% versus SITA 1.5%, p = 0.6). Diabetes ( p < 0.01) and nonelective surgery ( p = 0.004) were the only predictors of mediastinitis in the entire population. Propensity score matching showed no differences in mediastinitis: BITA 2.5% versus SITA 1.3% ( p = 0.17). Conclusions In this series of patients, BITA did not increase the risk of mediastinitis in the total population or in the propensity score matched subgroups.]]></abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>27659597</pmid><doi>10.1016/j.athoracsur.2016.06.080</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Aged Cardiothoracic Surgery Case-Control Studies Female Humans Internal Mammary-Coronary Artery Anastomosis - adverse effects Male Mediastinitis - etiology Middle Aged Surgery |
title | Bilateral Internal Thoracic Artery Grafting Increases Mediastinitis: Myth or Fact? |
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