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Outcomes in single versus bilateral internal thoracic artery grafting in coronary artery bypass surgery
Jon-Cecil M Walkes1, Nan Earle, Michael J Reardon
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
Insights
Bilateral internal thoracic artery (ITA) grafting for coronary artery bypass grafting (CABG) shows similar early outcomes to single ITA use. However, careful patient selection is advised, especially for smokers, due to potential mediastinitis risks.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- The internal thoracic artery (ITA) is frequently used as a graft in CABG.
- Bilateral ITA grafting may offer advantages but requires careful consideration of patient factors.
Purpose of the Study:
- To compare early outcomes between single and bilateral ITA grafting in CABG patients.
- To identify potential risk factors associated with bilateral ITA use.
Main Methods:
- Retrospective analysis of 1,069 patients undergoing CABG between 1990 and 2000.
- Comparison of early outcomes (perioperative myocardial infarction, renal failure, reoperation for bleeding, stroke, operative mortality, and mediastinitis) between single ITA (n=911) and bilateral ITA (n=158) groups.
- Statistical analysis to determine differences between the groups, considering factors like tobacco abuse.
Main Results:
- No significant differences in perioperative myocardial infarction, renal failure, reoperation for bleeding, stroke, or operative mortality between single and bilateral ITA groups.
- A trend towards higher mediastinitis incidence in the bilateral ITA group (4.4%) compared to the single ITA group (2.2%), though not statistically significant (P=0.0602).
- Higher incidence of tobacco abuse observed in the bilateral ITA group (56.7%) versus the single ITA group (40.3%).
Conclusions:
- Early outcomes following CABG with bilateral ITA grafting are comparable to those with single ITA grafting.
- Patient selection for bilateral ITA grafting requires careful consideration, particularly in patients with a history of smoking.
- Further investigation may be warranted to clarify the association between smoking and mediastinitis risk in bilateral ITA grafting.
Abstract:
The authors analyzed the early outcomes in two groups of patients undergoing coronary artery bypass grafting (CABG) with single versus bilateral internal thoracic arteries (ITA) in their institution. One thousand sixty-nine patients underwent CABG with single or bilateral ITAs from 1990 to 2000. Of these patients, 911 (85.2%) had single ITA and 158 had bilateral ITA (14.8%). The incidence of tobacco abuse was 40.3% in the single ITA group and 56.7% in the double ITA group (P = 0.0001). The incidence of perioperative myocardial infarction, renal failure, reoperation for bleeding, stroke, or operative mortality did not differ in the two groups. There was a 4.4% incidence of mediastinitis in the bilateral ITA group versus 2.2% in the single ITA group (P = 0.0602). Early outcomes after bilateral ITA grafting for CABG are similar to single ITA grafting. Careful judgment should be exercised in selecting patients for bilateral ITA grafting, particularly if the patient smokes.