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Bilateral internal thoracic artery grafting with and without cardiopulmonary bypass: six-year clinical outcome
Antonio M Calafiore1, Gabriele Di Giammarco, Giovanni Teodori
1Division of Cardiac Surgery, University Hospital, Torino, Italy. calafiore@unich.it
Insights
Off-pump coronary artery bypass grafting (CABG) using bilateral internal thoracic arteries offers similar early and late outcomes compared to on-pump CABG. This study found no significant differences in mortality or complications between the two surgical approaches.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Bilateral internal thoracic artery grafting is a preferred strategy for myocardial revascularization.
- The choice between off-pump and on-pump techniques remains a subject of ongoing clinical debate.
- Evaluating long-term outcomes is crucial for determining the optimal surgical approach.
Purpose of the Study:
- To compare early and late clinical outcomes of off-pump versus on-pump myocardial revascularization using bilateral internal thoracic arteries.
- To assess the safety and efficacy of off-pump coronary artery bypass grafting in extensive arterial revascularization.
Main Methods:
- A propensity score-matched analysis of 1194 patients undergoing isolated myocardial revascularization with bilateral internal thoracic artery grafting.
- Patients were divided into two groups: off-pump (n=597) and on-pump (n=597).
- Follow-up included clinical events and postoperative angiography.
Main Results:
- Overall 30-day mortality was similar between off-pump (1.2%) and on-pump (1.8%) groups (P=.342).
- No significant differences in other complications or six-year outcomes (including death, cardiac death, myocardial infarction, reoperation) were observed.
- Postoperative angiography revealed similar graft patency in both groups after a mean follow-up of 30.7 months.
Conclusions:
- Off-pump myocardial revascularization with bilateral internal thoracic artery grafting can be performed safely.
- Technical advancements have enabled off-pump surgery to achieve comparable late results to on-pump procedures.
- Extensive arterial revascularization using the off-pump technique is a viable option with equivalent long-term efficacy.
Objectives:
We sought to evaluate whether early and late results in patients who underwent off-pump or on-pump myocardial revascularization with bilateral internal thoracic artery grafting were similar.
Methods:
From November 1994 through December 2001, 1835 patients underwent isolated myocardial revascularization with bilateral internal thoracic artery grafting. By applying propensity score pairwise matching, 1194 patients were selected and operated on either off pump (n = 597) or on pump (n = 597).
Results:
The overall 30-day mortality was 1.5% (1.2% in the off-pump group and 1.8% in the on-pump group, P = .342). There was no difference for all the other complications between the 2 groups. Mean follow-up was 5.2 +/- 1.8 years. Forty-two patients died over the follow-up period (22 in the off-pump group and 20 in the on-pump group), 15 of them of cardiac causes (7 in the off-pump group and 8 in the on-pump group). Six-year outcomes (freedom from death, cardiac death, acute myocardial infarction and reoperation in all or in the grafted area, target cardiac events, and any other event) were similar for both categories. After a mean of 30.7 +/- 20.1 months, 202 patients had a postoperative angiography showing similar results.
Conclusions:
Our results with extensive arterial revascularization clearly show that with the technical improvements achieved in the most recent years, off-pump operations can be performed safely with the same quality of late results as those obtained with on-pump operations.