Abstract 3246: Skeletonization of Internal Thoracic Arteries: Is it Safe in Long-term?
Bibliographic record
Abstract
Background: Skeletonization of internal thoracic arteries (ITA) is a popular technique in OPCAB surgery to increase length of arterial conduit and feasibility of «No-touch» revascularization. Impact of skeletonized (SK) ITA on long-term survival and cardiac events is not clearly defined. Methods: We reviewed 1000 consecutive patients having undergone OPCAB surgery at the Montreal Heart Institute, between September 1996 and March 2004 that were prospectively recorded in an OPCAB database. Among them, 994 had at least one ITA bypass. Results: Skeletonized ITA was used in 558 patients (56.1%). SK patients were older (p=0.045), had significantly more risk factors [dyslipidemia (p<0.001), hypertension (p<0.001), obesity (p=0.002)]. Preoperative Parsonnet score was not different between SK and non-SK groups. Use of bilateral ITA (p<0.001) and sequential grafting (p<0.001) were more frequent in SK group (36.6% vs 25.7% and 29.9% vs 0.7%, respectively). Operative mortality was similar (SK: 1.8% vs non-SK: 1.6%; p=0.82). Sternal wound infection rate was similar, but dehiscence rate was higher in the PD group (p=0.03). Hospital (p=0.27) and ICU (p=0.09) length of stay were similar in both groups. Overall 7-year survival was 83±2% in SK group and 80±2% in non-SK group (p=0.84). Long-term freedom from major adverse cardiac events was also similar between SK and non-SK groups (83±2% and 82±2%, respectively, p=0.4). Late rate rehospitalization for heart failure or revascularization (CABG or PCI) was similar for both groups. However, 7-year freedom from myocardial infarction was significantly better for non-SK group (p=0.04). By Cox regression analysis, COPD, cardiac heart failure, peripheral vascular disease, emergency and completeness of revascularization were independent predictors of late mortality whereas diabetes, skeletonization and the number of grafts by territory of revascularization were independent predictors of late myocardial infarction. Conclusion: ITA has no influence in long-term survival or major cardiac events in an all comer OPCAB population. However, SK and diabetes were predictors of late incidence of myocardial infarction. Thus, a word of caution should be made about skeletonization of the ITA in diabetic population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".