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Total arterial revascularization: achievable and prognostically effective - a multicenter analysis

Tatoulis, James, Wynne, Rochelle, Skillington, Peter D. and Buxton, Brian F. 2015, Total arterial revascularization: achievable and prognostically effective - a multicenter analysis, The annals of thoracic surgery, vol. 100, no. 4, pp. 1268-1275, doi: 10.1016/j.athoracsur.2015.03.107.

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Title Total arterial revascularization: achievable and prognostically effective - a multicenter analysis
Author(s) Tatoulis, James
Wynne, Rochelle
Skillington, Peter D.
Buxton, Brian F.
Journal name The annals of thoracic surgery
Volume number 100
Issue number 4
Start page 1268
End page 1275
Total pages 8
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2015-10
ISSN 1552-6259
Keyword(s) Aged
Coronary Artery Bypass
Middle Aged
Myocardial Revascularization
Proportional Hazards Models
Risk Factors
Surgical Wound Infection
Treatment Outcome
Summary BACKGROUND: Total arterial revascularization (TAR) is adopted to overcome late vein graft atherosclerosis, and occlusion. Uptake of TAR remains low despite reports suggesting superior survival. Previous studies primarily involved single sites and short-term follow-up. We report the influence of TAR on long-term survival in a large multicenter patient cohort.
METHODS: We reviewed 63,592 cases from an audited collaborative multicenter database. Of those, 34,181 consecutive patients undergoing first-time isolated coronary artery bypass (CABG) from 2001 to 2012 were studied. The data were linked to the National Death Index. We compared outcomes in patients who underwent TAR (n = 12,271) with outcomes in those who did not (n = 21,910). The influence of TAR on 10-year all-cause late mortality was assessed by propensity score analyses in 6,232 matched pairs.
RESULTS: The 30-day mortality was 0.8% (96/12,271) for TAR patients and 1.8% (398/21,910) for non-TAR patients (p < 0.001). Late mortality was 7.5% (918/12,271) for TAR patients and 8.9% (1,952/21,910) for non-TAR patients (p < 0.001). The mean follow-up time was 4.9 years. In the propensity-matched cohort, the perioperative mortality was 0.9% (53/6,232) for TAR patients versus 1.2% (76/6,232) for non-TAR patients (p < 0.001). Kaplan-Meier survival in the matched cohort at 1, 5, and 10 years was 97.2%, 91.3%, and 85.4% for TAR patients and 96.5%, 90.1%, and 81.2% for non-TAR patients (p < 0.001). Late mortality was 8.0% (n = 500) for TAR patients and 10.0% (n = 622) for non-TAR patients (p < 0.001). Stratified Cox proportional hazards models showed lower risk for all-cause late mortality in the TAR group (TAR:HR 0.80, 95% confidence interval 0.71 to 0.90, p < 0.001).
CONCLUSION: TAR is associated with low perioperative mortality and, importantly, improved long-term survival and could be used more liberally.
Language eng
DOI 10.1016/j.athoracsur.2015.03.107
Field of Research 110399 Clinical Sciences not elsewhere classified
1103 Clinical Sciences
1102 Cardiovascular Medicine And Haematology
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, The Society of Thoracic Surgeons
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Document type: Journal Article
Collection: School of Nursing and Midwifery
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