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Two internal thoracic artery grafts are better than one
B W Lytle1, E H Blackstone, F D Loop
1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
The Journal of Thoracic and Cardiovascular Surgery
|April 30, 1999
Summary
Using bilateral internal thoracic artery (ITA) grafts for coronary bypass surgery significantly reduces the risk of death, reoperation, and angioplasty compared to single ITA grafts. Bilateral ITA grafting offers long-term survival benefits.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common treatment for coronary heart disease.
- Internal thoracic artery (ITA) grafts are associated with superior long-term patency rates compared to vein grafts.
- The incremental benefit of using bilateral ITA grafts over a single ITA graft remains a subject of investigation.
Purpose of the Study:
- To evaluate whether bilateral internal thoracic artery (ITA) grafts offer incremental benefits compared to single ITA grafts in patients undergoing coronary bypass surgery.
- To assess the long-term outcomes, including survival, reoperation rates, and need for percutaneous transluminal coronary angioplasty (PTCA), associated with single versus bilateral ITA grafting.
Main Methods:
- Retrospective, nonrandomized study of 10,124 patients undergoing elective primary isolated coronary bypass surgery.
- Comparison of outcomes between patients receiving single ITA grafts (8123) and bilateral ITA grafts (2001).
- Application of advanced statistical methods, including propensity score matching and multivariable analyses, to control for patient selection and heterogeneity.
Main Results:
- In-hospital mortality was similar (0.7%) in both groups.
- Long-term survival at 5, 10, and 15 years was significantly higher for the bilateral ITA group (94%, 84%, 67%) compared to the single ITA group (92%, 79%, 64%) (P <.001).
- Bilateral ITA grafting was associated with significantly lower rates of death, reoperation, and PTCA, with the most pronounced difference observed in reoperation rates, even after statistical adjustments.
Conclusions:
- Bilateral internal thoracic artery (ITA) grafting provides significant long-term survival advantages over single ITA grafting in coronary bypass surgery.
- The use of bilateral ITA grafts is associated with a reduced risk of subsequent adverse cardiovascular events, including death, reoperation, and angioplasty.
- No patient subsets were identified where single ITA grafting demonstrated a clear advantage over bilateral ITA grafting.
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