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Updated: Mar 22, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Complete myocardial revascularization using only bilateral internal thoracic arteries provides a low-risk and durable
David Glineur1,2, Spiridon Papadatos3, Juan B Grau4
1Department of Thoracic and Cardiovascular Surgery, Cliniques St Luc, Bouge, Belgium dglineur@ottawaheart.ca.
Insights
Bilateral internal thoracic artery (BITA) bypass using Y-composite grafts on an off-pump platform offers excellent long-term survival and protection from major adverse cerebral and cardiovascular events (MACCEs). This strategy demonstrates sustained efficacy for coronary artery bypass grafting (CABG).
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Bilateral internal thoracic artery (BITA) bypass offers superior long-term survival compared to single internal mammary arteries in coronary artery bypass grafting (CABG).
- The adoption rate of BITA strategies remains low, with ongoing debate regarding optimal configuration and the necessity of cardiopulmonary bypass.
- Investigating off-pump techniques with composite BITA-Y grafts is crucial for improving CABG outcomes.
Purpose of the Study:
- To evaluate the long-term efficacy of an exclusive BITA-Y composite graft strategy using an off-pump platform.
- To assess survival rates and freedom from major adverse cerebral and cardiovascular events (MACCEs) in patients undergoing this specific CABG approach.
- To determine the optimal BITA configuration and the role of off-pump surgery in coronary revascularization.
Main Methods:
- A cohort of 2057 patients undergoing isolated CABG between March 2000 and November 2010 utilized an off-pump platform.
- 784 patients with three-vessel coronary disease received exclusive BITA-Y composite grafts with a no-touch technique, avoiding aortic manipulation.
- Long-term survival and MACCEs were the primary endpoints, with follow-up completed via the annual anniversary method.
Main Results:
- The mean number of anastomoses per patient was 4.0, with low hospital mortality (1%) and minimal 90-day stroke (0.7%) and myocardial infarction (0.6%) rates.
- At 5 and 10 years, survival rates were 93.1% and 83.8%, respectively. Freedom from MACCEs at 10 years was 96.1%.
- Patency rates for left and right internal thoracic arteries in the BITA-Y configuration were 91.1% and 88.8% at a mean follow-up of 5 years.
Conclusions:
- An exclusive composite BITA off-pump revascularization strategy provides optimal and sustained long-term protection from MACCEs.
- This technique is a safe and effective alternative for coronary artery bypass grafting, particularly for patients with complex coronary artery disease.
- The findings support the wider adoption of off-pump BITA-Y composite grafting for improved patient outcomes.
Objectives:
Bilateral internal thoracic artery (BITA) bypass provides long-term survival benefits over strategies that use single internal mammary arteries during coronary artery bypass grafting (CABG). However, the rate of adoption of this strategy remains very low. Moreover, optimal BITA configuration and the use of cardiopulmonary bypass still remain a matter of debate. We investigated the long-term results of a coronary revascularization strategy, utilising exclusively BITA-Y composite grafts using off-pump platform and sequential anastomoses.
Methods:
From March 2000 to November 2010, all isolated CABGs (n = 2057 patients) were performed using an off-pump platform. Of these, 1240 patients had three-vessel coronary disease (60.3%), with severe coronary disease defined as >70% stenosis and three-vessel disease defined as the presence of 3 vessels with >70% stenosis, of which 784 (63.2%) were treated with two internal thoracic artery grafts in a composite fashion with a no-touch technique avoiding any manipulation of the ascending aorta. The primary end-point was the long-term survival and freedom from major adverse cerebral and cardiovascular events (MACCEs). The follow-up was completed using the annual anniversary method.
Results:
The mean number of anastomoses per patient was 4.0. Hospital mortality occurred in 8 patients (1%). Ninety-day stroke, myocardial infarction and repeat revascularization rates were respectively 0.7, 0.6 and 0.3%. The mean follow-up was 6.6 ± 3.2 years and was obtained for 99% of the patients. The 5- and 10-year survival rates were 93.1 ± 1.6 and 83.8 ± 3.2%, respectively. Freedom from major adverse cardiac and cardiovascular event (MACCE) at 5 and 10 years was: cardiovascular event: 98.7 ± 1.6 and 96.1 ± 1.7%, documented ischaemia: 90.5 ± 2 and 80.2 ± 3.8%, revascularization: 94.0 ± 1.5 and 89.7 ± 2.5%, infarction: 98.1 ± 0.8 and 96.0 ± 1.6%. The patency of left and right internal thoracic artery in a BITA-Y configuration was 91.1 and 88.8% at 5 ± 3 years, respectively.
Conclusion:
Performance of an exclusive composite BITA off-pump revascularization strategy optimal and sustained long-term protection from MACCE.
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