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[Single versus bilateral internal thoracic artery grafts for multi vessel coronary artery bypass grafting: mid-term
Habib Ben Ahmed1, Mehdi Chelli, Khalifa Selmi
1Hopital Mongi Slim, La Marsa, Tunis, Tunisie.
Insights
This study found similar early and mid-term clinical outcomes for patients undergoing single internal thoracic artery (SIMA) plus saphenous vein grafting compared to bilateral internal thoracic artery (BIMA) grafting for multivessel coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Grafting
Context:
- The optimal internal thoracic artery (ITA) grafting strategy for multivessel coronary artery bypass grafting (CABG) remains debated.
- Comparing single ITA (SIMA) versus bilateral ITA (BIMA) grafting is crucial for patient outcomes.
Purpose:
- To compare the early and midterm clinical outcomes of SIMA plus saphenous vein grafting (SVG) versus BIMA plus SVG in patients undergoing multivessel CABG.
- To evaluate differences in mortality, sternal wound infection, and event-free survival between SIMA and BIMA grafting.
Summary:
- A retrospective study of 196 patients undergoing primary multivessel CABG between 2005 and 2010 compared SIMA (n=145) and BIMA (n=51) grafting with SVG.
- Early results showed similar in-hospital mortality (6.9% vs 5.9%) and sternal wound infection rates (2.8% vs 3.9%).
- Midterm follow-up (mean 29 months) revealed comparable mortality (4% vs 4.8%) and event-free survival (75% vs 85.7% at 28 months).
Impact:
- The findings suggest that both SIMA and BIMA grafting strategies yield similar early and midterm clinical outcomes for multivessel CABG.
- This evidence can inform surgical decision-making regarding ITA utilization in coronary artery bypass procedures.
- Further research may explore long-term outcomes and specific patient subgroups benefiting from each approach.
Background:
The issue of superiority of single internal thoracic artery grafting versus bilateral internal thoracic artery grafting remains unresolved.
Aim:
The aim of this study was to compare the early results and midterm outcome of single and bilateral internal thoracic artery grafting for multivessel coronary artery bypass grafting.
Methods:
Between January 2005 and March 2010, 196 patients underwent primary coronary artery bypass grafting with at least one internal thoracic artery grafts. Early results and Outcomes of patients undergoing single internal thoracic artery (SIMA) plus saphenous vein grafting (n=145) and bilateral internal thoracic artery (BIMA) plus saphenous vein grafting (n=51) were obtained at a mean followup of 29 months.
Results:
Patients with bilateral internal thoracic artery grafting were younger, had less hypertension, higher left main disease and better Euroscore than patients undergoing single internal thoracic artery grafting. In-hospital mortality was similar for the two groups: 6.9 % for patients undergoing SIMA versus 5.9 % for those undergoing BIMA (p=0.8). Sternal wound infection was also similar (2.8% versus 3.9% p=0.68). Mid-term mortality was (4% VS 4.8% p=0.71) and event free survival probability at 28 months was 75% for the single-graft group compared with 85.7% for the bilateral-graft group (P =0.46).
Conclusion:
Our study found similar early and mid-term clinical outcomes for patients undergoing SIMA plus saphenous vein grafting and those undergoing BIMA plus saphenous vein grafting for multivessel coronary artery bypass grafting.
