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Background: Mortality after coronary artery bypass grafting (CABG) has been reported to be higher in women. The aim of this study was to evaluate whether bilateral internal thoracic artery (BITA) grafting in women has a long-term survival benefit over single internal thoracic artery grafting, possibly equivalent to the male population., Methods: A retrospective review was undertaken of our prospectively collected database. We included 4406 consecutive patients who underwent isolated CABG, who received their operation between January 2000 and April 2017. From the entire series, 2979 patients (67.6%) received exclusively BITA grafts; 299 (10.1%) were female. The primary end point was follow-up mortality, independently from cause. In-hospital mortality and during follow-up were analyzed. Substratification according to age was performed to answer whether it has an effect. Multivariable Cox proportional hazard analyses was performed to investigate the significant predictors of late mortality., Results: The median follow-up was 5.1 ± 3.9 years. Female BITA patients were older (P < .001), had nonelective surgery (P < .001), more on-pump CABG (P = .015), fewer number of grafts (P < .001) versus male BITA patients. BITA grafting in women had a long-term survival equivalent to that of men (P = .784). In a Cox proportional hazard model, female sex was not an independent risk factor for late death (B, -0.303; hazard ratio, 0.739; 95% confidence interval, 0.470-1.16; P = .189). The stratification analysis showed that the beneficial effect of BITA remained similar among sexes and was not modified by age even after adjusting for confounders. In a risk-adjusted sample, patients older than 65 years with BITA grafting showed superior long-term survival than those with single internal thoracic artery grafting (P = .019)., Conclusions: Although there are some differences between sexes, BITA grafting in women was associated with similar 10-year survival compared with men, and female sex was not an independent risk factor for late death. Among women, the BITA group had better survival, especially those older than 65 years., (Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: We studied long-term survival using bilateral internal thoracic artery (BITA) grafting in a T-configuration exclusively versus using single internal thoracic artery (SITA) grafting in patients with multivessel disease., Methods: Consecutive coronary operations performed at a single center between 1996 and 2014 were reviewed. Long-term survival among patients receiving coronary revascularization exclusively with BITA grafting in a T-configuration (n = 2,098) versus SITA grafts plus other types of conduits (saphenous vein graft [SVG] and radial artery [RA]) grafts (n = 1,659). In patients who underwent BITA grafting, the left internal thoracic artery (LITA) was grafted mainly to the left anterior descending artery, whereas the right internal thoracic artery (RITA) was used more commonly to graft the circumflex (Cx) artery and the right coronary system as T-grafts. A total of 485 pairs of patients were matched using propensity scores. Cox proportional hazard models were generated to examine the association of arterial BITA grafting with mortality., Results: Patients in the BITA group were more likely to be younger (BITA, 63.7 ± 9.1 versus SITA, 65.0 ± 9.9; p < 0.0001). At 30 days, patients who underwent BITA grafting experienced reduced unadjusted mortality (BITA, 1.2% versus SITA, 4.4%; p < 0.0001). At 10 years, patients who underwent BITA grafting experienced superior unadjusted survival (BITA, 82.6% ± 1.8% versus SITA, 76.1% ± 1.3%; p = 0.001). Cox regression analysis in the entire study cohort showed that BITA grafting was associated with improved survival (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.58-0.87; p < 0.001). In the propensity-score-adjusted analysis, patients who underwent BITA grafting had similar in-hospital mortality (BITA, 1.6% versus SITA, 2.9%; p = 0.196). Patients who underwent BITA grafting still showed improved survival at 10 years (BITA, 81.0% ± 4.1% versus SITA, 71.8% ± 2.5%; p = 0.039)., Conclusions: This study suggests that coronary artery operations exclusively with BITA grafting in a T-configuration may be associated with better long-term survival than grafting with SITA plus other types of conduits., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Seasonal variations of Stanford Type A dissections (STADs) have been previously described in the Northern Hemisphere (NH). This study sought to determine if these variation are mirrored in the Southern Hemisphere (SH)., Methods: Data from patients treated surgically for STADs were retrospectively obtained from existing administrative and clinical databases from NH and SH sites. Data points of interest included age, sex, date of dissection, and 30-day mortality. The dates of dissections (independent of year) were then organized by season., Results: A total of 1418 patients were identified (729 NH and 689 SH) with complete data available for 1415; 896 patients were male with a mean age was 61 ± 14 years, and the overall 30-day mortality was 17.3%. Comparison of NH and SH on a month-to-month basis demonstrated a 6-month phase shift and a significant difference by season, with STADs occurring predominantly in the winter and least in the summer. Decomposition of the monthly incidence using Fourier analysis revealed the phase shift of the primary harmonic to be -21.9 and 169.8 degrees (days), respectively, for NH and SH. The resultant 191.7 day difference did not exactly correspond to the anticipated 6-month difference but was compatible with the original hypothesis., Conclusion: Chronobiology plays a role in the occurrence of STADs with the highest occurrence in the winter months independent of the hemisphere. Season is not the predominant reason why aortas dissect, but for patients at risk, the increase in systemic vascular resistance during the winter months may account for the seasonal variations seen.

Objective: The purpose of this study was to evaluate the feasibility and safety of immediate extubation (ultrafast-track anesthesia [UFTA]) in the operating room, and the predictors of when not to attempt it in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB)., Design: Case series., Setting: A private hospital., Participants: One thousand one hundred ninety-six patients undergoing OPCAB surgery, representing 4 years of a single anesthesia service's practice (3 anesthesiologists), were evaluated for immediate extubation. All patients were considered amenable to immediate extubation if specific criteria were met., Intervention: Patients received general anesthesia (UFTA protocol) and underwent off-pump coronary artery bypass graft surgery., Measurements and Main Results: One thousand sixty-five patients (89%) met extubation criteria and were extubated successfully in the operating room. By multivariate analysis, the following independent predictors of avoiding immediate extubation were identified: reoperation (odds ratio [OR] = 3.9, p < 0.001), pre-existing renal disease (OR = 3.1, p < 0.0001), diabetes (OR = 1.7, p < 0.007), preoperative intra-aortic balloon pump placement (OR = 7.4, p < 0.0001), and total surgical time (OR = 3.7, p < 0.0001). Patients who met extubation criteria had lower in-hospital reintubation (2.5% v 16%, p < 0.001), myocardial infarction (1.03% v 4.58%, p = 0.001), renal insufficiency (2.2% v 7.63%, p < 0.001), stroke (0.4% v 2.29%, p = 0.032), and mortality rates (1.2% v 10.7%, p < 0.001) than patients who did not., Conclusions: UFTA is feasible and safe in most patients undergoing OPCAB surgery. Baseline and intraoperative data predicted when immediate extubation should not be attempted., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: The aim of our study was to evaluate the impact of recent clopidrogel use before off-pump coronary artery bypass grafting on the postoperative risk of bleeding., Methods: During the period January 2003 to December 2006, 1104 consecutive patients underwent off-pump coronary artery bypass grafting. Patients were divided into two groups according to the recent use of clopidrogel (within 7 days). We performed a propensity score to further adjust for differences between the patients with and without recent use of clopidrogel., Results: Mean age was 64 +/- 14 years and 87% were male. The clopidrogel group had a greater incidence of patients in unstable condition, requiring emergency coronary bypass grafting, and with a high EuroSCORE. Propensity score analysis selected 88 patients with and 176 without recent use of clopidrogel. By propensity score, the clopidrogel group had higher requirements for fresh frozen plasma units (18.1% vs 8.5%; P = .02), reoperation owing to bleeding (5.6% vs 0.5%; P = .009), and higher need for postoperative mechanical ventilation (4% vs 10%; P = .04), whereas mortality and length of stay were similar between groups., Conclusion: Recent use of clopidogrel before off-pump coronary artery bypass grafting is associated with greater risk for bleeding with similar mortality rate.