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Myocardial Revascularization Exclusively With Bilateral Internal Thoracic Arteries in T-Graft Configuration: Effects
Daniel O Navia1, Mariano Vrancic1, Fernando Piccinini1
1Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
Insights
Bilateral internal thoracic artery (BITA) grafting in a T-configuration demonstrated superior long-term survival compared to single internal thoracic artery (SITA) grafting in patients with multivessel disease. This arterial grafting strategy offers improved outcomes for coronary artery bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery disease (CAD) necessitates surgical revascularization for multivessel disease.
- Internal thoracic artery (ITA) grafts are preferred conduits for coronary artery bypass grafting (CABG) due to superior patency rates.
- The optimal configuration for utilizing bilateral internal thoracic arteries (BITA) remains an area of investigation.
Purpose of the Study:
- To compare long-term survival outcomes between exclusive T-configuration BITA grafting and single internal thoracic artery (SITA) grafting in patients with multivessel CAD.
- To evaluate the association of arterial grafting strategies with overall mortality.
Main Methods:
- A retrospective review of consecutive coronary operations performed between 1996 and 2014 at a single center.
- Comparison of long-term survival between patients receiving T-configuration BITA grafts (n=2,098) and SITA grafts with other conduits (n=1,659).
- Propensity score matching (485 pairs) and Cox proportional hazard models were employed to analyze mortality associations.
Main Results:
- BITA grafting was associated with reduced unadjusted 30-day mortality (1.2% vs. 4.4%) and superior unadjusted 10-year survival (82.6% vs. 76.1%).
- Cox regression analysis revealed BITA grafting was linked to improved survival (HR, 0.71; P < 0.001).
- Propensity-score-adjusted analysis showed similar in-hospital mortality but maintained improved 10-year survival for BITA (81.0% vs. 71.8%).
Conclusions:
- Exclusive T-configuration BITA grafting may be associated with enhanced long-term survival compared to SITA grafting combined with other conduits.
- Arterial grafting strategies significantly impact long-term patient outcomes in multivessel coronary artery disease.
- The T-configuration approach utilizing BITA warrants consideration for improved CABG results.
Background:
We studied long-term survival using bilateral internal thoracic artery (BITA) grafting in a T-configuration exclusively versus using single internal thoracic artery (SITA) grafting in patients with multivessel disease.
Methods:
Consecutive coronary operations performed at a single center between 1996 and 2014 were reviewed. Long-term survival among patients receiving coronary revascularization exclusively with BITA grafting in a T-configuration (n = 2,098) versus SITA grafts plus other types of conduits (saphenous vein graft [SVG] and radial artery [RA]) grafts (n = 1,659). In patients who underwent BITA grafting, the left internal thoracic artery (LITA) was grafted mainly to the left anterior descending artery, whereas the right internal thoracic artery (RITA) was used more commonly to graft the circumflex (Cx) artery and the right coronary system as T-grafts. A total of 485 pairs of patients were matched using propensity scores. Cox proportional hazard models were generated to examine the association of arterial BITA grafting with mortality.
Results:
Patients in the BITA group were more likely to be younger (BITA, 63.7 ± 9.1 versus SITA, 65.0 ± 9.9; p < 0.0001). At 30 days, patients who underwent BITA grafting experienced reduced unadjusted mortality (BITA, 1.2% versus SITA, 4.4%; p < 0.0001). At 10 years, patients who underwent BITA grafting experienced superior unadjusted survival (BITA, 82.6% ± 1.8% versus SITA, 76.1% ± 1.3%; p = 0.001). Cox regression analysis in the entire study cohort showed that BITA grafting was associated with improved survival (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.58-0.87; p < 0.001). In the propensity-score-adjusted analysis, patients who underwent BITA grafting had similar in-hospital mortality (BITA, 1.6% versus SITA, 2.9%; p = 0.196). Patients who underwent BITA grafting still showed improved survival at 10 years (BITA, 81.0% ± 4.1% versus SITA, 71.8% ± 2.5%; p = 0.039).
Conclusions:
This study suggests that coronary artery operations exclusively with BITA grafting in a T-configuration may be associated with better long-term survival than grafting with SITA plus other types of conduits.
