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Are two internal thoracic artery grafts as safe as one? Experience from Green Lane Hospital
Arul Baradi1, Paget F Milsom, Alan F Merry
1Department of General Medicine, Auckland City Hospital, Auckland. New Zealand.
Insights
Bilateral internal thoracic artery (BITA) grafts showed no significant difference in short-term mortality or morbidity compared to single internal thoracic artery (SITA) grafts in coronary artery bypass grafting (CABG). These findings support considering BITA grafts for selected patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- Internal thoracic artery (ITA) grafts are frequently used due to their long-term patency rates.
- Bilateral internal thoracic artery (BITA) grafting versus single internal thoracic artery (SITA) grafting is debated regarding short-term outcomes.
Purpose of the Study:
- To compare short-term mortality and major morbidity between BITA and SITA grafts in elective primary isolated CABG.
- To evaluate the safety and efficacy of BITA grafting in a New Zealand cohort.
Main Methods:
- Retrospective analysis of 5955 SITA and 637 BITA graft patients undergoing elective primary isolated CABG (1990-2004).
- Primary outcome: composite endpoint of early death, perioperative myocardial infarction, reoperation for sternal wound complications, or prolonged hospital stay.
- Case-matching was employed to control for confounding factors between BITA and SITA groups.
Main Results:
- No statistically significant difference in the primary composite endpoint between BITA and SITA graft groups (OR 0.84; 95% CI 0.59-1.21).
- No significant difference in reoperation rates for sternal wound complications between the two groups (OR 1.00; 95% CI 0.29-3.44).
Conclusions:
- Short-term outcomes are comparable between BITA and SITA grafting in selected patients undergoing elective primary isolated CABG.
- The study supports the consideration of BITA grafting due to potential long-term clinical benefits.
- Further research may explore long-term survival and graft patency differences.
Aim:
To compare short-term mortality and major morbidity between patients undergoing elective primary isolated CABG with bilateral internal thoracic artery (BITA) or single internal thoracic artery (SITA) grafts at Green Lane Hospital (Auckland, New Zealand).
Methods:
We conducted a retrospective study of short-term outcomes in 5955 patients receiving SITA and 637 patients receiving BITA grafts between 1990 and 2004. Only patients undergoing elective primary isolated coronary artery surgery were included. The primary outcome was a composite end-point (early death, perioperative MI, reoperation for sternal wound complications or significantly prolonged hospital stay). Patients receiving BITA grafts were case-matched with patients receiving SITA grafts for confounding factors and comparison was made between perioperative outcomes in the two groups.
Results:
After case-matching, no statistically significant difference was found in the incidence of our primary endpoint between patients receiving BITA versus SITA grafts [odds ratio 0.84 (95% CI 0.59, 1.21)]. Furthermore, there was no difference in rates of reoperation for sternal wound complications between the two groups [odds ratio 1.00 (95% CI 0.29, 3.44)].
Conclusions:
Given the potential long-term clinical advantages of BITA grafting, our results support the increased use of BITA grafts in selected patients.
