Hospital Volume and Outcome after Bilateral Internal Mammary Artery Grafting
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Published:2020-07-08
Issue:4
Volume:23
Page:E475-E481
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ISSN:1522-6662
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Container-title:The Heart Surgery Forum
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language:
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Short-container-title:HSF
Author:
Perrotti Andrea,Reichart Daniel,Gatti Giuseppe,Faggian Giuseppe,Onorati Francesco,De Feo Marisa,Chocron Sidney,Dalén Magnus,Santarpino Giuseppe,Rubino Antonino S.,Maselli Daniele,Gherli Riccardo,Salsano Antonio,Nicolini Francesco,Zanobini Marco,Bounader Karl,Rosato Stefano,Tauriainen Tuomas,Juvonen Tatu,Mariscalco Giovanni,G. Ruggieri Vito,Biancari Fausto
Abstract
Background: Bilateral internal mammary artery (BIMA) grafting largely is underutilized in patients undergoing coronary artery bypass grafting (CABG), partly because of the perceived increased complexity of the procedure.
Aims: In this study, we evaluated whether BIMA grafting can safely be performed also in centers, where this revascularization strategy infrequently is adopted.
Methods: Out of 6,783 patients from the prospective multicenter E-CABG study, who underwent isolated non-emergent CABG from January 2015 to December 2016, 2,457 underwent BIMA grafting and their outcome was evaluated in this analysis.
Results: The mean number of BIMA grafting per center was 82 cases/year and hospitals were defined as high or low volume, according to this cutoff value. Six hospitals were considered as centers with a high volume of BIMA grafting (no. of procedures ranging from 120 to 267/year; overall: 2,156; prevalence: 62.2%) and nine hospitals as centers with a low volume of BIMA grafting (no. of procedures ranging from 2 to 39/year; overall: 301; prevalence: 9.1%). Multilevel mixed-effects regression analysis showed that the low- and high-volume cohorts had similar outcomes. Propensity score one-to-one matching analysis of 292 pairs showed that the low-volume cohort had a significantly shorter intensive care unit stay (2.2 ± 2.3 versus 2.9 ± 4.8 days, P = .020). The rates of in-hospital death (1.0% versus 0.3%, P = .625), deep sternal wound infection/mediastinitis (3.8% versus 3.1%, P = .824), and 1-year survival (98.1% versus 99.7%, P = .180) as well as other outcomes were similar between the high- and low-volume cohorts.
Conclusions: BIMA grafting can be safely performed also in centers in which this revascularization strategy is infrequently performed.
Publisher
Carden Jennings Publishing Co.
Subject
Cardiology and Cardiovascular Medicine,Surgery,General Medicine