Related Experiment Video

Updated: Jun 13, 2026

A Murine Model of Hemodialysis Access-Related Hand Dysfunction
08:39

A Murine Model of Hemodialysis Access-Related Hand Dysfunction

Published on: May 31, 2022

Does off-pump bilateral internal thoracic artery grafting increase operative risk in dialysis patients?

Takeshi Kinoshita1, Tohru Asai, Soh Hosoba

  • 1Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan. kinotake@belle.shiga-med.ac.jp

The Heart Surgery Forum
|May 7, 2010
PubMed

Insights

Bilateral internal thoracic artery (BITA) grafting is safe for dialysis patients with multivessel disease. This surgical technique showed comparable short-term outcomes to single internal thoracic artery (SITA) grafting, including mortality and wound healing.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Patients on chronic dialysis often have multivessel coronary artery disease.
  • Internal thoracic artery grafting is a preferred method for coronary artery bypass grafting.
  • Comparing bilateral (BITA) versus single (SITA) internal thoracic artery grafting in dialysis patients is crucial for optimizing outcomes.

Purpose of the Study:

  • To compare short-term outcomes of bilateral internal thoracic artery (BITA) grafting versus single internal thoracic artery (SITA) grafting in patients on chronic dialysis undergoing coronary artery bypass grafting.
  • To evaluate the safety and feasibility of BITA grafting in this high-risk population.

Main Methods:

  • Retrospective comparison of 56 dialysis patients with multivessel disease undergoing isolated coronary artery bypass grafting (99.1% off-pump) between 2002 and 2008.
  • Patients were divided into BITA (n=32) and SITA (n=23) grafting groups.
  • Propensity score analysis using 13 preoperative factors was employed to minimize selection bias.

Main Results:

  • No significant differences in baseline characteristics (age, LVEF, diabetes, logistic euroSCORE) between BITA and SITA groups.
  • All patients underwent off-pump coronary artery bypass grafting with complete revascularization using skeletonized arterial conduits.
  • No significant differences were observed in mediastinitis, impaired wound healing, or stroke between the groups. 30-day mortality was 6.3% for BITA vs. 13.0% for SITA (P=.64).
  • Adjusted propensity score analysis showed BITA grafting was not associated with impaired wound healing (OR 0.63) or increased 30-day mortality (OR 0.60).

Conclusions:

  • In situ skeletonized bilateral internal thoracic artery grafting is a safe and feasible surgical option for dialysis patients with multivessel coronary artery disease.
  • BITA grafting demonstrates comparable short-term outcomes to SITA grafting in this patient population, including wound healing and mortality.
  • The findings support the use of BITA grafting in selected dialysis patients to potentially improve long-term outcomes.
Abstract

More Related Videos

Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft05:25

Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft

Published on: September 15, 2023

Related Concept Videos

Hemodialysis I: Introduction01:25

Hemodialysis I: Introduction

Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
Hemodialysis II: Procedure and Complications01:24

Hemodialysis II: Procedure and Complications

DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...
Peripheral Artery Disease V: Postoperative Nursing Management01:23

Peripheral Artery Disease V: Postoperative Nursing Management

During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...