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Long-term results of bilateral internal thoracic artery grafting in dialysis patients
Masashi Kai1, Hitoshi Okabayashi, Michiya Hanyu
1Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyusyu City, Fukuoka, Japan.
Insights
Bilateral internal thoracic artery (BITA) grafting showed better long-term outcomes in dialysis patients compared to single internal thoracic artery (SITA) grafting, with no significant difference in perioperative results or hospital mortality.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Evaluating surgical techniques for coronary artery bypass grafting (CABG) in patients with chronic kidney disease on dialysis.
- Assessing the safety and efficacy of bilateral internal thoracic artery (BITA) versus single internal thoracic artery (SITA) grafting.
Purpose of the Study:
- To compare the perioperative and long-term outcomes of BITA grafting versus SITA grafting in dialysis patients undergoing isolated CABG.
- To determine if BITA grafting offers superior long-term results in this high-risk population.
Main Methods:
- Retrospective comparison of 101 consecutive dialysis patients undergoing isolated CABG.
- Patients were categorized into BITA grafting (n=76) or SITA grafting (n=25) groups.
- Analysis included perioperative outcomes, hospital mortality, and long-term survival and cardiac events.
Main Results:
- No significant difference in hospital mortality or mediastinitis rates between BITA and SITA groups.
- BITA group demonstrated a trend toward better survival and freedom from cardiac mortality.
- Freedom from composite cardiac events was significantly superior in the BITA group (p=0.03).
- Independent risk factors for late death included aortic calcification, peripheral vascular disease, diabetes, and age.
Conclusions:
- BITA grafting in dialysis patients yields comparable perioperative results to SITA grafting.
- Long-term outcomes, particularly freedom from cardiac events, are superior with BITA grafting in this population.
- The findings support the continued use of BITA grafting for dialysis patients requiring CABG.
Background:
We evaluated the perioperative and long-term results of bilateral internal thoracic artery grafting in dialysis patients.
Methods:
One hundred one consecutive patients on chronic dialysis who underwent isolated coronary artery bypass grafting were retrospectively compared according to the surgical technique, bilateral internal thoracic artery (BITA) grafting (n = 76) or single internal thoracic artery (SITA) grafting (n = 25).
Results:
Hospital mortality was 5.3% in the BITA group and 8.0% in the SITA group (p = not significant). The incidence of mediastinitis was not different (7.9% in the BITA group and 8.0% in the SITA group). The median duration of follow-up was 3.1 years (range, 0.1 to 10.9). Survival and freedom from cardiac mortality were not different between the two groups, but the BITA group had a trend toward better results. Freedom from cardiac events (including cardiac-related death, myocardial infarction, percutaneous coronary intervention, redo coronary artery bypass grafting, and congestive heart failure) was superior in the BITA group (p = 0.03). Calcification of the ascending aorta, peripheral vascular disease, insulin-dependent diabetes mellitis, and age were the independent risk factors of late death.
Conclusions:
Perioperative results of BITA grafting in dialysis patients were not different from the results of SITA grafting. However, the long-term results of BITA grafting in dialysis patients were better than the results of SITA grafting. Overall, our results support the continued use of BITA grafting in dialysis patients.
