Related Experiment Video
Updated: May 29, 2026
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
Off-pump bilateral versus single skeletonized internal thoracic artery grafting in high-risk patients
Takeshi Kinoshita1, Tohru Asai, Tomoaki Suzuki
1Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan. kinotake@belle.shiga-med.ac.jp
Insights
Bilateral internal thoracic artery (ITA) grafting in high-risk patients undergoing off-pump coronary artery bypass surgery significantly reduces the risk of death and cardiac events compared to single ITA grafting. This approach offers improved long-term survival without increasing operative complications.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery Outcomes
Background:
- High-risk patients undergoing coronary artery bypass graft (CABG) surgery present unique challenges.
- The choice between single and bilateral internal thoracic artery (ITA) grafting impacts long-term outcomes.
Purpose of the Study:
- To compare the outcomes of off-pump CABG using bilateral versus single skeletonized ITA in high-risk patients.
- To evaluate the impact of ITA grafting strategy on long-term survival and cardiac events.
Main Methods:
- Retrospective analysis of 536 high-risk patients (European System for Cardiac Operative Risk Evaluation [EuroSCORE] ≥ 5) undergoing off-pump CABG.
- Propensity score matching was used to compare outcomes between patients receiving single (n=236) or bilateral (n=300) skeletonized ITA grafting.
- Mean follow-up was 3.2 years, with 5-year survival and cardiac event rates analyzed.
Main Results:
- Postoperative complication rates were similar between single and bilateral ITA groups.
- Five-year survival free from death or cardiac events was significantly higher in the bilateral ITA group (85.8%) compared to the single ITA group (74.8%).
- Multivariate analysis showed bilateral ITA grafting was associated with a significantly lower risk of overall death (HR, 0.56) and cardiac events (HR, 0.40).
Conclusions:
- Off-pump skeletonized bilateral in situ ITA grafting is superior to single ITA grafting in high-risk patients.
- Bilateral ITA grafting is associated with improved long-term survival and reduced cardiac events without increasing operative risk.
- This strategy represents a valuable option for improving outcomes in complex CABG patients.
Background:
We compared the outcomes in propensity score-matched high-risk patients (European System for Cardiac Operative Risk Evaluation [EuroSCORE] ≥ 5) undergoing off-pump coronary artery bypass graft surgery using bilateral or single skeletonized internal thoracic artery (ITA).
Methods And Results:
Of 794 consecutive patients undergoing isolated coronary artery bypass graft surgery (788 by the off-pump technique without emergent conversion to cardiopulmonary bypass), the 536 who had a EuroSCORE ≥ 5 and underwent off-pump skeletonized single (n=236) or bilateral (n=300) ITA were retrospectively analyzed after excluding the 6 who were transferred to our hospital after receiving percutaneous cardiopulmonary support, the 45 who had only 1 target in the left-side coronary area, and the 207 with EuroSCORE <5. A total of 235 pairs were matched using propensity scores calculated from 7 preoperative factors (C statistic, 0.65). The rate of postoperative complications was similar between the groups. The mean observation period was 3.2 years. The 5-year estimated survival rate free from overall death and cardiac event in patients receiving bilateral versus single ITA grafting was 85.8 ± 5.5% versus 74.8 ± 4.9% (P=0.002) and 87.4 ± 4.6% versus 66.1 ± 5.7% (P=0.001), respectively. In multivariate Cox proportional hazard models, bilateral ITA grafting was significantly associated with a lower risk of overall death (hazard ratio, 0.56; 95% CI, 0.32 to 0.87; P=0.009) and cardiac event (hazard ratio, 0.40; 95% CI, 0.24 to 0.69; P=0.001).
Conclusions:
In high-risk patients, off-pump skeletonized left-sided bilateral in situ ITA grafting is associated with lower risk of overall death and cardiac event than single ITA grafting without increased operative risk.
