Ann Thorac Surg 1996;62:22
© 1996 The Society of Thoracic Surgeons
Discussion
Discussion
See also page 16.
DR CARY W. AKINS (Boston, MA): Obviously the patient population is loaded at the front end by patients having largely saphenous vein grafting and at the back end by more patients having internal mammary grafting, which can have some impact when looking at late results. Particularly when talking about long-term survival, one has to account for a surgeon's selection of patients in whom to use internal mammary grafting. Have you looked at risk factors to be able to predict what caused late death and whether the internal mammary was actually a predictor of better survival by multivariate analysis?
DR MORRIS: We have not looked at late survival in terms of multivariate analysis. However, we looked at cohorts between the two groups and found that there was no significant selection bias on the part of the surgeon. It was presumed that the surgeon may have selected a healthier patient, but we found that not to be so, and we did not find a single predictor indicating that.
DR CONSTANTINE E. ANAGNOSTOPOULOS (New York, NY): Following the lead of Dr George Green, our three teams at St. Luke's Hospital have been doing exactly what Dr Morris and Dr Brockman have been doing, and we have noticed actually slightly improved results when looking at deaths and complications. In fact, The Society of Thoracic Surgeons showed last year (if I remember correctly) for the first time that use of the internal mammary artery, even in emergency operation, resulted in improved survival. I suspect that as we speak, The Society and the national database will have the answer as to whether the internal thoracic artery is the graft of choice in patients who are in their ninth decade. Do you have access to that information?
DR MORRIS: I am sorry, sir, but I do not have access to the information for The Society database. However, we do operate on patients in the ninth decade of life and use the internal mammary arteries. In our experience, these arteries actually made a better graft than the saphenous vein.
Related Article
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Internal Thoracic Artery for Coronary Artery Grafting in Octogenarians
- Rohinton J. Morris, Michael D. Strong, Karl E. Grunewald, M. L. Ray Kuretu, Louis E. Samuels, J. Yasha Kresh, and Stanley K. Brockman
Ann. Thorac. Surg. 1996 62: 16-22.
[Abstract]
[Full Text]
