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T Carrel

Publications and source records attributed to T Carrel.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Acute type B aortic dissection: prognosis after initial conservative treatment and predictive factors for a complicated course].

OBJECTIVE: Today there is still debate concerning the optimal mode of treatment for type B dissection of the aorta. Controversies are mainly due to discordant results regarding survival following medical or surgical treatment. We assessed the early and long-term outcome of acute dissection of the descending aorta after initial conservative treatment. METHODS: Between 1980 and 1995, 225 patients were hospitalized in the medical or surgical department of our institution with the diagnosis of acute type B aortic dissection. 38 patients (16.8%) underwent replacement of the descending aorta within the first week after hospital admission. Primary indications for immediate surgery were rupturing aneurysm in 15 patients, extensive dilatation of the descending aorta in 13, distal malperfusion in 8, and pseudocoarctation syndrome with uncontrollable hypertension in 2. All other patients (n = 187) underwent primary conservative treatment in the intensive care unit, which included appropriate antihypertensive medication. RESULTS: Hospital mortality during and after initial conservative treatment was 17.6% (33/187 patients). Main causes of death were rupture in 14 patients, intestinal malperfusion in 13 and cardiac failure in 3, whereas in 3 patients the cause of death could not be determined. Nine additional patients had to be referred for early surgery during the initial hospitalization because of contained rupture (n = 4), rapidly increasing size of the aorta (n = 2) and suspected intestinal ischemia (n = 3). Hospital mortality after early surgery was 21% (8/38 patients) for the overall time period. After hospital discharge from the initial acute dissection, surgery for chronic dissection was performed in 47 patients, mainly because of expanding descending aortic aneurysm. Hospital mortality was 8% in these patients (4/47). Actuarial survival rates after primary conservative therapy were 76 +/- 5% and 50 +/- 7% after 5 and 8 years respectively. CONCLUSION: Currently, surgery for acute type B dissection is limited to patients with rupturing disease, distal malperfusion or uncontrollable hypertension and pains. Despite aggressive antihypertensive treatment, hospital mortality after primary conservative treatment is still high and a substantial proportion of patients requires surgery during initial hospitalization. Although conservative treatment is recommended in most uncomplicated type B aortic dissections, early surgery should be considered in the following situations: younger patients with 5 cm diameter of the aorta at initial evaluation, as well as those with Marfan syndrome, patients with limited false aneurysm or retrograde dissection into the aortic arch, and those with poor medical compliance or uncontrollable proximal hypertension. Radiographic follow-up for an indefinite period may allow detection of potential late complications and proper planning of elective operations when indicated.

Acute Disease↗
PubMed1997

[Cardiovascular surgery in Marfan syndrome. A review with case examples].

It has been clearly recognized that the diagnosis, management and long-term follow-up of operated and non-operated Marfan patients require a multidisciplinary approach. Despite the high quality of medical care in this country, the diagnosis of Marfan syndrome will be delayed in a majority of the cases even if the patient has already been treated for one of the aspects of this disease. Indications for surgery have recently been simplified. Regarding aortic and mitral valve regurgitation, the indications for surgical repair are similar to those of non-Marfan patients. The aortic root and ascending aorta should be replaced when the diameter reaches 50 to 55 mm. In children and adolescents, surgery is considered indicated when the diameter of the diseased aortic segment is more than twice the diameter of the normally expected aortic arch. This review presents a single center experience in the surgical treatment of cardiovascular manifestations associated with Marfan syndrome and summarizes some interesting cases treated in the recent past. Despite the progress made in the fields of surgery, anesthesiology, intensive care and cardiology, the mortality of acute surgery because of aortic dissection remains about 10% whereas elective surgery can be performed with a perioperative risk of around 2%. Even if composite graft replacement gives excellent long-term results, some alternatives to this technique should be considered, especially in patients in whom anticoagulation with cumadines is not recommended. More recently, a Working group for Adult and Teenager Congenital Heart Disease (WATCH) has been established within the Swiss Society of Cardiology, with the aim of optimizing the management of grown-up patients with congenital heart defects. Marfan syndrome was included in the recommendations of this group. Follow-up before or after surgery is recommended at yearly (or half-yearly) intervals and should include echocardiography and/or computed tomography or magnetic resonance imaging. Finally, the patient and his family should be informed about the prognosis of the disease, the technical options in the treatment of cardiovascular manifestations, and the possibility of assistance from the Marfan Foundation.

Adolescent↗
PubMed1997

[Current techniques in heart surgery].

Significant advances in open heart surgery during the last two decades were achieved in the field of the extracorporal circulation and the preservation of the myocardium. In the last few years, new therapeutical tools were introduced to treat patients with coronary artery disease. The transmyocardial laser revascularization (TMR) technique was introduced for clinical investigation 1990. Despite limited experience with this device in selected patients, some conclusions after a short follow-up period are available. Patients treated with TMR have significantly less anginal pain and need fewer hospitalisations. With PET follow-up studies, a better subendocardial perfusion at the expense of the subepicardial perfusion was demonstrated. On the other hand, there was no substantial increase found in terms of ejection fraction in treated patients. Minimally invasive procedures have also gained acceptance during the last few years, especially the minimally invasive coronary artery bypass procedures (MIDCAB). Introduced initially to treat solitary stenoses of the LAD without cardiopulmonary bypass, this procedure is actually often used in conjunction with PTCA for three-vessel disease in selected patients. Due to the different methods used and summarized under the term of MIDCAB, definite conclusions about the advantages of this method are difficult to formulate. There is a trend to reduced patency rates of the IMA bypasses in MIDCAB procedures compared to the conventional technique due to the difficulty with limited access.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Surgery in congenital heart defects: current developments and a few case examples].

Congenital heart surgery includes the palliative treatment and surgical complete repair of cardiac malformations in newborns, children and adolescents. Palliative surgery allows early or long-term survival, depending on the primary malformation and the condition of the patient. Confection of a systemic-to-pulmonary shunt (the modified Blalock-Taussig shunt) allows in general recovery from severe cyanosis and leads to development of the hypoplastic pulmonary vascular tree in newborns with severe pulmonary stenosis. Longterm palliation can be applied to all patients in whom establishment of a biventricular heart can not be realized. The total cavo-pulmonary connection represents one possibility to bypass a single ventricle in these complex cases. Total repair allows the restitution of a completely normal anatomy and physiology after surgery; usually, this type of surgery is followed by a normalization of life expectancy with minimal pharmacotherapy. Preoperative diagnosis of congenital heart disease is reasonably performed by transthoracic echocardiography in the majority of cases. Cardiac catheterism is reserved for complex cases and those in which full hemodynamic evaluation is required for proper planning of surgery. Continuous improvement has been realized in the fields of cardiac anesthesiology and pediatric intensive care during the last decade; hence more and more complex cases have been accepted without any negative effect on the operative mortality. Additionally there has been a number of improvements in surgical and perfusion techniques, thus allowing open heart surgery in newborns with a minimal weight of 2000 g. Intraoperative transesophageal echocardiography is performed routinely and allows the proper control of surgical repair; furthermore this examination may be helpful during the weaning period from the extracorporeal circulation. There is a number of interesting topics that will take importance or will be developed in the near future: the role of interventional cardiology in pediatric patients gains more and more importance. There is a potential for minimally-invasive surgery and the number of potential candidates for heart transplantation may increase, due to the fate of long-term survivors after palliative surgery.

Aortic Coarctation↗
PubMed1997

[Logistics characteristics and surgical aspects of heart transplantation].

Orthotopic cardiac transplantation is an established treatment for terminal cardiac diseases. The organization of the operation closely depends on the successful team work between cardiologists, selecting the proper patients for this procedure, the anesthesiologists taking care of the multiorgan donor and the cardiac surgeons managing in parallel the donor and the recipient. Accurate donor evaluation and treatment are essential for a perfect graft function immediately after transplantation. Orthotopic heart transplantation can also be offered as a therapeutical option in adolescents presenting with end-stage heart failure due to complex congenital heart disease and who have sustained multiple previous operations. In this paper, some special logistic and technical particularities of cardiac transplantation are presented and discussed.

Assisted Circulation↗
PubMed1997

[Homograft in the therapy of cardiovascular diseases].

Despite considerable progress in prosthetic valve technology, there is actually no ideal artificial heart valve that may be employed in all circumstances, when replacement of a diseased aortic valve is necessary. The choice for optimal valve substitute includes mechanical prosthesis, bioprosthetic xenografts, homografts and pulmonary autografts. More recently an aortic valve sparing operation has been proposed in younger patients presenting with anulo-aortic ectasia. The use of homograft heart valves has now been widely accepted in the treatment of congenital heart defects, as well as for an increasing number of valvular pathologies, especially in infective endocarditis. Heart valve preservation by cryopreservation techniques helps to store the small amount of donor material for special indications without loss of quality, thus permitting elective surgery. In vascular surgery, some concern persists regarding the use of prosthetic material for the treatment of mycotic aneurysms and graft infection. In situ repair with a new vascular prosthesis and resection followed by extra-anatomic reconstruction carry a high peri-operative mortality and substantial morbidity. Cryopreserved vascular homografts represent a valuable alternative in these challenging situations.

Aortic Valve↗
PubMed1997

VATS-guided epicardial pacemaker implantation. Hand-sutured fixation of atrioventricular leads in an experimental setting.

BACKGROUND: In neonates and infants epicardial stimulation may be preferred to endocardial stimulation because of growth-associated lead problems and the risk of vascular complications associated with transvenous electrodes. This study analyzes the feasibility of atrioventricular implantation of a new epicardial lead using the video-assisted thoracic surgical (VATS) technique in an animal model. METHODS: Bipolar steroid-eluting epicardial leads were implanted in seven young white pigs. In five animals bipolar atrial and ventricular pacing leads (n = 10) were inserted and fixed by the VATS technique, while two animals served as controls and underwent implantation through anterolateral thoracotomy. Surgical feasibility, pacing, and sensing thresholds of the leads as well as hemodynamic parameters during pacing were studied. Histological changes beneath the electrodes were evaluated 1 week after the implantation. RESULTS: All animals survived the pacemaker lead implantation. One animal which underwent thoracotomy died because of irreversible ventricular fibrillation induced by rapid ventricular pacing. One animal in the VATS group exhibited intraoperative herniation of the heart through the pericardial window. All animals with left-sided VATS implantations demonstrated good individual pacing and sensing threshold values. The mean cardiac output was 1.6 times higher during AAI-mode pacing as compared to VVI-mode pacing at a heart rate of 140/min. One animal died postoperatively due to respiratory failure. No displacements of the pacemaker leads were observed in the survivors. CONCLUSION: While VATS-guided implantation of epicardial, atrial, and ventricular leads is feasible, technical improvements of the system are mandatory for safe clinical application.

Animals↗
PubMed1997

Perioperative risk and long-term results of heart transplantation after previous cardiac operations.

BACKGROUND: In recent years, there has been an increasing proportion of candidates for heart transplantation who have sustained one or several previous cardiac operations. This study analyzes the perioperative management and the long-term survival of patients undergoing orthotopic heart transplantation as a redo operation and compares the results with those obtained in patients undergoing transplantation as the first cardiac operation. METHODS: From October 1985 to October 1994, 204 heart transplantations were performed in 202 patients. Thirty-eight transplantations were performed in patients who had undergone prior cardiac operations because of coronary artery disease (n = 21) and valvular disease (n = 8) as well as one or several palliative or corrective procedures because of complex congenital heart disease (n = 9). These 38 patients were compared in a case-control fashion with 76 patients who underwent orthotopic cardiac transplantation as a primary cardiac procedure during the same period and using similar techniques. The majority of preoperative variables (hemodynamics, inotropic support, liver and renal function, coagulation, and priority to transplantation) were comparable in the two groups of patients. Mean age was significantly younger in the group of patients with a previous operation (42.2 +/- 9.5 versus 50.1 +/- 7.3 years; p < 0.001). RESULTS: Except the problem of more fastidious hemostasis, which is nowadays under better control since aprotinin has been routinely administered, the results show no significant difference in term of perioperative risk (hospital mortality: 5.2% in study group versus 7.8% in the control group) and long-term outcome. The 1-year survival rate was 92.7% +/- 3.6% in the study group versus 90.8% +/- 3.6% in the control group, and the 5-year survival rate was 79.4% +/- 4.5% versus 74.8% +/- 7.5%, respectively. CONCLUSIONS: These results are very acceptable and confirm the fact that carefully selected candidates for transplantation are not exposed to a particularly high perioperative risk when a prior cardiac operation has been performed. The incidences of early and late rejection episodes as well as the numbers of postoperative infections are similar in the two groups. Although multiple prior procedures do constitute significant risk factors for perioperative morbidity and mortality in isolated lung and heart-lung transplantation, this is not the case in heart transplantation.

Adult↗
PubMed1997

Extension of the "elephant trunk" technique in complex aortic pathology: the "bidirectional" option.

BACKGROUND: The "elephant trunk" technique, using a free-floating vascular prosthesis, was originally described to facilitate a subsequent operation on the downstream aorta. We developed an additional refinement of this technique, called the "bidirectional elephant trunk." This option may represent an interesting tool in more complex aortic operations, especially when the descending aorta has to be replaced first in patients with concomitant pathology of the ascending aorta or of the aortic arch. METHODS: The initial operation is performed through a left thoracotomy. The proximal elephant trunk is created by invaginating the future aortic arch graft into the descending aortic graft. The proximal anastomosis between the doubled graft and the proximal descending aorta is performed first. During construction of the distal anastomosis, a distal elephant trunk may be inserted likewise. If the aortic arch and ascending aorta have to be replaced later, this second step is performed through a median sternotomy. The free-floating arch graft is pulled out of the proximal descending aorta with a nerve hook, unfolded, and used for total arch replacement. RESULTS: This technique was used successfully in 3 patients without mortality. No major complications were observed excepted persistent hoarseness in a patient with preoperative paresis of the recurrent nerve. No perfusion problems due to the unfolding of the free-floating graft occurred during the second operation. CONCLUSIONS: The bidirectional elephant trunk technique is an interesting option that may be suitable for patients presenting with a complex pathology of the whole thoracic aorta when the descending segment has to be replaced first.

Anastomosis, Surgical↗
PubMed1997

Early and late outcome of operated and non-operated acute dissection of the descending aorta.

OBJECTIVE: At present debate continues concerning the optimal mode of treatment for type B dissections. Controversies are mainly due to discordant results regarding survival following medical or surgical treatment. We assessed early and long-term outcome of acute dissection of the descending aorta treated by emergency aortic replacement, medical treatment or delayed surgery. METHODS: Between 1980 and 1995, 225 patients were hospitalized in the medical or surgical department of our institution with the diagnosis of acute type B aortic dissection. A total of 38 patients (16.8%) underwent replacement of the descending aorta within the first week after hospital admission. Primary indications for immediate surgery were: rupturing aneurysm (n = 15), diameter of the descending aorta (n = 13), malperfusion of the thoracoabdominal aorta (n = 8) and pseudocoarctation syndrome with uncontrollable hypertension (n = 2). All other patients (n = 187) underwent primary conservative treatment on the intensive care unit, including appropriate anti-hypertensive medication. In 12 of them, surgery was denied because of age or significant concomitant diseases. RESULTS: Hospital mortality after urgent or emergency surgery was 21% (8/38 patients) for the overall time period. There has been a significant decrease in hospital mortality during the last 5 year-period (12% versus 30% between 1980 and 1994). Causes of death were: cardiac failure in 3, bleeding complications in 2, postoperative mesenteric ischemia in 2 and septicemia in one patient. From the 30 operative survivors, 9 (30%) patients required further surgery on the native aorta after a mean follow-up of 48 +/- 13 months. Hospital mortality during conservative treatment was 17.6% (33/187 patients). Main causes of death were rupture in 14, thoraco-abdominal malperfusion in 13 and cardiac failure in 3 patients, whereas in 3 patients, the cause of death could not be evaluated. In this group, 9 patients had to be shifted to early surgery during the initial hospitalization because of impending rupture (n = 4), rapidly increasing diameter (n = 2) and suspicion of intestinal ischemia (n = 3). After hospital discharge, surgery for chronic dissection was performed in 47 patients, mainly because of expanding descending aortic aneurysm. Hospital mortality was 8% (4/47 patients). Actuarial survival rates after surgery during the first admission were 85 +/- 6% at 5 years and 61 +/- 8% at 10 years, versus 76 +/- 5 and 50 +/- 7% respectively, following conservative treatment (P < 0.001). CONCLUSION: Nowadays, acute type B dissection can be treated surgically with a reasonable perioperative risk. Despite aggressive anti-hypertensive treatment, hospital mortality of primary conservative treatment is still high and a substantial percentage of patients requires surgery during initial hospitalization. Main causes of death in both groups are rupture and abdominal malperfusion: therefore, closed clinical and radiologic assessment of the whole thoraco-abdominal aorta is of utmost importance. Long-term results are satisfying; unlimited radiographic follow-up allows for detection of potential severe complications and for proper planning of elective reoperations when indicated.

Acute Disease↗
PubMed1997

Interrupted aortic arch, aorto-pulmonary window and aortic origin of the right pulmonary artery: single stage repair in a neonate.

Aorto-pulmonary window, interrupted aortic arch and abnormal origin of the right pulmonary artery from the aorta, combined with patent ductus arteriosus and with intact ventricular septum, is a very rare and complex cardiac malformation. We report one-stage repair in a 4 day-old neonate, using aortic homograft tissue to reconstruct the ascending aorta.

Aorta, Thoracic↗
PubMed1997

Early experience with the new Masters series of St. Jude Medical heart valve: in vivo hemodynamic and clinical results in patients with narrowed aortic annulus.

BACKGROUND AND AIMS OF THE STUDY: Aortic valve replacement in the small aortic root results in a heart-prosthesis mismatch in a significant number of patients. The new Masters series of St. Jude Medical (SJM) valves represents the company's most recent innovation, combining the beneficial Hemodynamic Plus (HP) characteristics with rotatability. Thus, this valve allows for a larger valve orifice area with an equivalent tissue annulus diameter and reduces the potential interferences of subannular tissue with leaflet mobility. METHODS: We compared prospectively the hemodynamic characteristics and the early clinical results in four groups of 25 patients each who received either the 21 Masters-HP, the 21 Standard, the 21 HP or the 23 Standard SJM valves. Patients were selected from our database and matched rigorously for age, gender, body surface area, NYHA functional class, underlying lesion, native valve opening area and left ventricular function, as well as preoperative peak and mean valve gradients. Postoperative evaluation included clinical examination and echocardiographic studies before hospital discharge and at six months. RESULTS: Short-term clinical follow up was marked by a complete absence of valve-related complications in all groups. Doppler-derived mean and maximal pressure gradients were significantly lower in the 21 HP (8.7 +/- 3.1 mmHg and 15.1 +/- 4.0 mmHg, respectively) and 21 Masters-HP groups (8.9 +/- 2.6 mm +/- Hg and 14.5 +/- 3.8 mmHg) than those in the 21 Standard group (15.1 +/- 3.2 mmHg and 22.5 +/- 6.1 mmHg; p = 0.002 and p = 0.004, respectively). These results confirm that the superior hemodynamic performance of the HP series is maintained in the Masters-HP valve, despite the introduction of a new cuff design allowing rotatability. Pressure gradients did not differ significantly between the 21 HP, the 21 Masters-HP and the 23 Standard groups. CONCLUSIONS: The hemodynamic performance of the 21 Masters-HP SJM valve corresponds closely with that of the 21 HP and 23 Standard valves and is substantially better than that of the 21 Standard valve. The Masters-HP valve will continue to reduce cardiac-prosthesis mismatch in normal-sized patients with a narrowed aortic root; its performance index is equal to that of the 21 HP valve and significantly higher than that of the 21 Standard valves. The valve will also further reduce the need for aortic annulus enlargement.

Aged↗
PubMed1996

Transposition of the great arteries complicated by tricuspid valve incompetence.

BACKGROUND: Tricuspid valve insufficiency secondary to structural anomalies of the valve itself or to an iatrogenic complication of the Rashkind procedure is very rarely associated with transposition of the the great arteries. This condition represents an interesting perioperative challenge. Rapid restoration of the tricuspid valve to a low-pressure system by arterial switch operation associated with tricuspid repair should theoretically improve the outcome in terms of myocardial and valve function. METHODS: Thirteen of 839 patients who underwent an arterial switch operation for various forms of transposition of the great arteries presented with moderate to severe tricuspid insufficiency. Three of them had a ventricular septum defect. Nine experienced severe cardiac failure with profound hypoxemia. Ventilatory support was necessary in 7, 6 had renal or hepatic dysfunction, and 5 had coagulation disorders. Inotropic support was started preoperatively in 8 patients. RESULTS: Tricuspid lesions were as follows: primary annular dilatation and lack of coaptation at the commissural level (n = 1), straddling tricuspid valve (n = 1) redundant tricuspid valve tissue leading to left ventricular outflow tract obstruction (n = 1), small cleft of the septal leaflet (n = 1), and dysplastic valve tissue with juxtacommissural regurgitation (n = 1). In 8 patients, the cause of the tricuspid valve insufficiency was most probably an iatrogenic lesion, with rupture of the papillary muscle (n = 2), rupture of the chordae (n = 1), or tear of the anterior leaflet (n = 5), whereas no clear cause could be found in 1 patient. Repair consisted of the arterial switch operation associated with tricuspid valve repair in 10 patients. In 2 patients with only discrete anomaly and in 1 without a clear cause of tricuspid regurgitation, no valve repair was performed. Three patients had their ventricular septal defect closed. There were only one early and one late death, both not related to the tricuspid lesions. Late postoperative (mean, 6.5 years) evaluation revealed normal left ventricular function in 10, with no tricuspid incompetence in 7 and trivial tricuspid insufficiency in 3. CONCLUSIONS: Restoration of an incompetent tricuspid valve in a low-pressure system by the arterial switch operation combined with valve repair provides good ventricular and valvar results. Preoperative management and appropriate timing of operation seem to be of utmost importance.

Female↗
PubMed1996

Early in vivo experience with the Hemodynamic Plus St. Jude Medical heart valves in patients with narrowed aortic annulus.

BACKGROUND: Small aortic orifice primarily resulted in heart prosthesis mismatch in a significant number of patients. The Hemodynamic Plus (HP) series of St. Jude Medical heart valves represents an interesting innovation, allowing a larger valve orifice area with an equivalent tissue annulus diameter. METHODS: Hemodynamic characteristics of the 21-mm HP St. Jude Medical valve were prospectively compared with those of the standard 21-mm and 23-mm St. Jude Medical valves in three groups of 22 patients. Patients were selected from a database to be rigorously matched for age, sex, body surface area, functional class, underlying lesion, native valve opening area, left ventricular function, and preoperative peak and mean valve gradients. Postoperative evaluation (follow-up ranging from 3 to 24 months; mean, 11.5 months) included clinical examination and echocardiographic studies. RESULTS: There was no operative mortality or significant perioperative complications. Short-term clinical follow-up was marked by a complete absence of valve-related complications. Presently, all but 1 patient in the 21-mm HP group and 2 in the 21-mm standard group are in New York Heart Association functional class I. Doppler echocardiography-derived mean and maximal pressure gradients were significantly lower in the 21-mm HP group (8.1 +/- 1.9 and 16.4 +/- 3.4 mm Hg) than in the 21-mm standard group (13.4 +/- 3.9 and 21.2 +/- 4.3 mm Hg; p = 0.002 and p = 0.0004, respectively), confirming the better hemodynamic performance already described in in vitro studies. Pressure gradients did not differ significantly between the 21-mm HP and the 23-mm standard groups. The 21-mm HP valve demonstrated the highest performance index; 0.66 +/- 0.08, compared with 0.49 +/- 0.09 for the 21-mm standard valve (p < 0.001) and 0.59 +/- 0.07 for the 23-mm standard valve (p < 0.001). CONCLUSIONS: In vivo hemodynamic performance of the 21-mm HP valve corresponds closely to that of the 23-mm standard valve and is substantially better than that of the 21-mm standard valve. The 21-mm HP St. Jude Medical valve demonstrates excellent hemodynamic characteristics and can be recommended in normal-sized adult patients with narrow aortic root. This valve will minimize the need for aortic annulus enlargement.

Adult↗
PubMed1996

Operation for two-vessel coronary artery disease: midterm results of bilateral ITA grafting versus unilateral ITA and saphenous vein grafting.

BACKGROUND: Several studies have demonstrated that single internal thoracic artery (ITA) grafting achieves better results than the use of vein grafts alone, but it is less clear whether bilateral ITA grafting produces better long-term results than a single ITA graft to the left descending coronary artery does. METHODS: We analyzed the early and midterm results of the surgical treatment of two-vessel coronary artery disease (left anterior descending artery and right coronary artery) in two groups of 80 consecutive patients operated on between 1985 and 1989 who received either a bilateral ITA graft or a unilateral ITA graft combined with a saphenous vein graft. Patients were selected from a data base so as to be rigorously matched for demographic and clinical factors as well as angiographic variables, with the researcher being blinded to any additional intraoperative or postoperative data. Follow-up examination was performed after a mean postoperative interval of 8 years. RESULTS: Univariate analysis showed a somewhat higher incidence of sternal complications in the bilateral ITA group (4.8% versus 1.2%; p < 0.02) and a significantly lower reintervention-free survival at 8 years in the group of patients who received a unilateral ITA and saphenous vein graft (84% +/- 5.5% versus 95% +/- 1.5%; p < 0.02). The latter was predominantly due to the development of significant main stem lesions necessitating a redo procedure during the follow-up interval or to the need for percutaneous coronary angioplasty of circumflex artery lesions that were not critical at the time of the initial operation. Perioperative risk was similar in both groups of patients. Old age and a history of congestive heart failure were the most important predictors of perioperative mortality and morbidity for patients receiving bilateral ITAs. Multivariate analysis did not demonstrate any benefit from bilateral arterial grafting over unilateral ITA bypass combined with saphenous vein grafting in terms of overall survival and event-free and intervention-free survival. CONCLUSIONS: Although bilateral ITA grafting can be performed with a perioperative risk comparable with that for unilateral ITA and saphenous vein grafting, long-term results (up to 8 years) of surgically treated two-vessel coronary artery disease are not improved by bilateral ITA grafting.

Aged↗