Related Experiment Video
Updated: May 25, 2026
Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation
Published on: October 11, 2024
Bilateral internal thoracic artery grafting improves long-term survival in patients with reduced ejection fraction: a
David L Galbut1, Paul A Kurlansky, Ernest A Traad
1Aventura Medical Center, Aventura, FL, USA. david@dgalbutmd.com
Insights
Bilateral internal thoracic artery (BITA) grafting enhances long-term survival after coronary artery bypass grafting without increasing operative risk. This study supports broader consideration of BITA for patients with reduced ejection fraction (EF).
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Bilateral internal thoracic artery (BITA) grafting improves long-term survival in coronary artery bypass grafting (CABG).
- Hesitancy exists in using BITA in higher-risk patients, including those with reduced ejection fraction (EF).
- Reduced EF is associated with higher operative risk and poorer long-term survival post-CABG.
Purpose of the Study:
- To evaluate perioperative and long-term outcomes of BITA versus single internal thoracic artery (SITA) grafting.
- To assess the safety and efficacy of BITA in patients with reduced EF.
- To determine if BITA offers survival benefits over SITA in this patient cohort.
Main Methods:
- A retrospective analysis of 4537 patients undergoing SITA or BITA grafting between 1972 and 1994.
- Patients categorized by EF: <0.30 (Group I), 0.30-0.50 (Group II), >0.50 (Group III).
- Propensity score matching created comparable SITA and BITA cohorts for each EF group; survival analyzed using log-rank and Cox regression.
Main Results:
- No significant difference in operative mortality or postoperative complications between matched SITA and BITA groups across all EF categories.
- BITA grafting significantly enhanced 10- and 20-year survival in patients with EF 0.30-0.50 (Group II) and EF >0.50 (Group III).
- BITA use was a significant predictor of reduced late mortality in Groups II and III.
Conclusions:
- Broadly applied BITA grafting provides superior long-term survival compared to SITA.
- BITA grafting does not increase operative mortality or morbidity in patients with normal or reduced EF.
- Expanded use of BITA grafting should be strongly considered for CABG patients.
Objective:
Bilateral internal thoracic artery (BITA) grafting has been shown to improve long-term survival after coronary artery bypass grafting. However, there has been reluctance to use this technique in higher-risk patients. Patients with reduced ejection fraction (EF) have been shown to present a higher operative risk and reduced long-term survival. We studied the perioperative and long-term results of BITA versus single internal thoracic artery grafting (SITA) in a large population of patients with reduced EF in whom BITA grafting was broadly applied.
Methods:
Between February 1972 and May 1994, 4537 consecutive patients in whom EF was recorded underwent SITA (2340) or BITA (2197) grafting. Prospectively collected clinical data recorded EF categorically as less than 0.30 (group I; n = 233), 0.30 to 0.50 (group II; n = 1256), or greater than 0.50 (group III; n = 3048). Multivariable analyses were performed to determine correlates of operative and late mortality. Optimal matching using propensity scoring was used to create matched SITA and BITA cohorts: group I, SITA and BITA, n = 87 each; group II, SITA and BITA, n = 448 each; group III, SITA and BITA, n = 1137 each. Equality of survival distribution was tested by the log-rank algorithm.
Results:
There was no difference in operative mortality between matched SITA and BITA groups (group I: SITA vs BITA, 10.3% vs 6.9%, P = .418; group II: 4.7% vs 4.5%, P = .873; group III: 3.2% vs 2.0%, P = .086). SITA versus BITA was not a predictor of operative mortality on logistic regression analysis. There was no difference in freedom from any postoperative complication, including sternal wound infection, between matched SITA and BITA groups. Late survival was significantly enhanced with the use of BITA grafting in groups II and III (10- and 20-year survival, SITA vs BITA, in group II: 57.7% ± 0.3% and 19% ± 2.5% vs 62.0% ± 2.3% and 33.1% ± 3.4%, respectively, P = .016; and in group III: 67.1% ± 1.4% and 35.8% ± 1.7% vs 74.6% ± 1.3% and 38.1% ± 2.1%, respectively, P = .012). Likewise, choice of SITA versus BITA was a significant predictor of late mortality on Cox regression in both groups II (P < .007) and III (P < .001).
Conclusions:
Broadly applied BITA compared with SITA grafting in propensity-matched patients provides enhanced long-term survival with no increase in operative mortality or morbidity for patients with normal and reduced EF. The expanded use of BITA grafting should be seriously considered.
