Related Experiment Video
Updated: Jun 14, 2026
Murine Kidney Transplant Technique
Published on: October 20, 2015
Efficacy of bilateral internal thoracic artery grafting in patients with chronic kidney disease
Takeshi Kinoshita1, Tohru Asai, Yoshitaka Murakami
1Division of Cardiovascular Surgery, Department of Health Statistics, Shiga University of Medical Science, Setatsukinowa, Otsu, Japan. kinotake@belle.shiga-med.ac.jp
Insights
Bilateral internal thoracic artery (ITA) grafting significantly improves long-term survival in chronic kidney disease patients compared to single ITA grafting. This approach reduces both overall and cardiac death rates, offering a survival benefit.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Medical Outcomes Research
Background:
- Chronic kidney disease (CKD) is a significant comorbidity in patients undergoing coronary artery bypass grafting (CABG).
- The choice of arterial graft (single vs. bilateral internal thoracic artery - ITA) may impact long-term outcomes in CKD patients.
Purpose of the Study:
- To compare short-term and long-term survival outcomes between bilateral ITA and single ITA grafting in CKD patients.
- To assess the specific benefit of bilateral ITA grafting for survival in this high-risk population.
Main Methods:
- A propensity score-matched analysis was conducted on 157 pairs of CKD patients (no dialysis history) undergoing isolated CABG (predominantly off-pump).
- Propensity scores were derived from 13 preoperative factors to minimize selection bias.
- Patients aged >85 or with only one target vessel in the left coronary area were excluded.
Main Results:
- Over a mean follow-up of 2.9 years, bilateral ITA grafting showed significantly lower rates of overall death (5.1% vs. 15.9%, p=0.01) and cardiac death (1.3% vs. 8.3%, p=0.01) compared to single ITA grafting.
- Multivariate analysis confirmed that bilateral ITA grafting was independently associated with a reduced risk of overall death (HR, 0.29; 95% CI, 0.10-0.89; p=0.03) and cardiac death (HR, 0.14; 95% CI, 0.03-0.63; p=0.02).
Conclusions:
- Bilateral ITA grafting offers superior long-term survival benefits for patients with chronic kidney disease undergoing coronary artery bypass grafting.
- The use of bilateral ITA grafts should be strongly considered in CKD patients to improve their long-term prognosis.
Background:
This study compared short-term and long-term outcomes in propensity score-matched patients with chronic kidney disease receiving bilateral internal thoracic artery (ITA) or single ITA grafting and assessed any benefit of bilateral ITA grafting for survival.
Methods:
Among 656 consecutive patients undergoing isolated coronary artery bypass grafting (99.1% by off-pump technique) between 2002 and 2008, 361 had chronic kidney disease with no history of dialysis. After excluding 10 patients who would not be potential candidates for bilateral ITA grafting because they were aged older than 85 years and 15 who had only one target vessel at the left coronary area, we identified 157 propensity score-matched pairs. Propensity scores were created based on 13 preoperative factors (C statistics, 0.787).
Results:
During a mean observation of 2.9 years, the rates of overall death and cardiac death (myocardial infarction, heart failure, and sudden death) in the bilateral ITA group were significantly lower than those in the single ITA group (5.1% vs 15.9%, p=0.01; 1.3% vs 8.3%, p=0.01). In multivariate Cox models including bilateral ITA grafting and all other potential predictors, bilateral ITA grafting was significantly associated with a lower risk for overall death (hazard ratio, 0.29; 95% confidence interval, 0.10 to 0.89; p=0.03) and cardiac death (hazard ratio, 0.14; 95% confidence interval, 0.03 to 0.63; p=0.02).
Conclusions:
Among patients with chronic kidney disease, bilateral ITA grafting provides better long-term survival than single ITA grafting.
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