Incidence and clinical implications of intraoperative BITA grafts conversion. Insights from the Arterial Revascularization Trial

<strong>Background</strong> The arterial revascularization trial (ART) has been designed to answer the question whether the use of bilateral internal thoracic arteries (BITA) can improve 10-year outcomes when compared to single internal thoracic artery (SITA). In the ART, a significant p...

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المؤلفون الرئيسيون: Benedetto, U, Altman, D, Flather, M, Gerry, S, Gray, A, Lees, B, Taggart, D, on behalf of the ART investigators
التنسيق: Journal article
منشور في: Elsevier 2018
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author Benedetto, U
Altman, D
Flather, M
Gerry, S
Gray, A
Lees, B
Taggart, D
on behalf of the ART investigators
author_facet Benedetto, U
Altman, D
Flather, M
Gerry, S
Gray, A
Lees, B
Taggart, D
on behalf of the ART investigators
author_sort Benedetto, U
collection OXFORD
description <strong>Background</strong> The arterial revascularization trial (ART) has been designed to answer the question whether the use of bilateral internal thoracic arteries (BITA) can improve 10-year outcomes when compared to single internal thoracic artery (SITA). In the ART, a significant proportion of patients initially allocated to BITA received other conduit strategies. We sought to investigate the incidence and clinical implication of BITA grafts conversion in the ART. <strong>Methods</strong> Among patients enrolled in the ART (n=3102), we excluded those allocated to SITA (n=1554), those who did not undergo surgery (n=16) and those operated on but withdrew after randomization (n=7). Propensity score matching was used to compare converted vs non-converted BITA groups. <strong>Results</strong> A total of 1525 patients were operated with intention to receive BITA grafting. Of those, 233 (15.3%) were converted to other conduit selection strategies. Incidence of conversion largely varied across 28 centres involved (from 0% to 42.9%). The most common reason for BITA grafts conversion was the evidence of at least one internal thoracic artery not suitable which was reported in 77 cases. Patients with intraoperative BITA graft conversion received a lower number of grafts (2.95±0.84 vs 3.21±0.74; P&lt;0.001). However, hospital mortality rate was comparable to those who did not require BITA graft conversion (0 vs 1.6%; P=0.1) as well as the incidence of major complications. At 5 years we found a non-significant excess of deaths (11.9% vs 8.4%; P=0.1) and major adverse events (17.1% 13.2%; P=0.1) mainly driven by an excess of revascularization in patients requiring conversion. <strong>Conclusions</strong> The incidence of intraoperative BITA graft conversion is not irrelevant . BITA graft conversion is not associated with increased operative morbidity but its effect on late outcomes remain uncertain.
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spelling oxford-uuid:5dd4d67c-c5b4-43b8-a8cf-8e454f7de90d2022-03-26T17:36:44ZIncidence and clinical implications of intraoperative BITA grafts conversion. Insights from the Arterial Revascularization TrialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:5dd4d67c-c5b4-43b8-a8cf-8e454f7de90dSymplectic Elements at OxfordElsevier2018Benedetto, UAltman, DFlather, MGerry, SGray, ALees, BTaggart, Don behalf of the ART investigators<strong>Background</strong> The arterial revascularization trial (ART) has been designed to answer the question whether the use of bilateral internal thoracic arteries (BITA) can improve 10-year outcomes when compared to single internal thoracic artery (SITA). In the ART, a significant proportion of patients initially allocated to BITA received other conduit strategies. We sought to investigate the incidence and clinical implication of BITA grafts conversion in the ART. <strong>Methods</strong> Among patients enrolled in the ART (n=3102), we excluded those allocated to SITA (n=1554), those who did not undergo surgery (n=16) and those operated on but withdrew after randomization (n=7). Propensity score matching was used to compare converted vs non-converted BITA groups. <strong>Results</strong> A total of 1525 patients were operated with intention to receive BITA grafting. Of those, 233 (15.3%) were converted to other conduit selection strategies. Incidence of conversion largely varied across 28 centres involved (from 0% to 42.9%). The most common reason for BITA grafts conversion was the evidence of at least one internal thoracic artery not suitable which was reported in 77 cases. Patients with intraoperative BITA graft conversion received a lower number of grafts (2.95±0.84 vs 3.21±0.74; P&lt;0.001). However, hospital mortality rate was comparable to those who did not require BITA graft conversion (0 vs 1.6%; P=0.1) as well as the incidence of major complications. At 5 years we found a non-significant excess of deaths (11.9% vs 8.4%; P=0.1) and major adverse events (17.1% 13.2%; P=0.1) mainly driven by an excess of revascularization in patients requiring conversion. <strong>Conclusions</strong> The incidence of intraoperative BITA graft conversion is not irrelevant . BITA graft conversion is not associated with increased operative morbidity but its effect on late outcomes remain uncertain.
spellingShingle Benedetto, U
Altman, D
Flather, M
Gerry, S
Gray, A
Lees, B
Taggart, D
on behalf of the ART investigators
Incidence and clinical implications of intraoperative BITA grafts conversion. Insights from the Arterial Revascularization Trial
title Incidence and clinical implications of intraoperative BITA grafts conversion. Insights from the Arterial Revascularization Trial
title_full Incidence and clinical implications of intraoperative BITA grafts conversion. Insights from the Arterial Revascularization Trial
title_fullStr Incidence and clinical implications of intraoperative BITA grafts conversion. Insights from the Arterial Revascularization Trial
title_full_unstemmed Incidence and clinical implications of intraoperative BITA grafts conversion. Insights from the Arterial Revascularization Trial
title_short Incidence and clinical implications of intraoperative BITA grafts conversion. Insights from the Arterial Revascularization Trial
title_sort incidence and clinical implications of intraoperative bita grafts conversion insights from the arterial revascularization trial
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