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Updated: Mar 21, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Urgent Coronary Revascularization with Bilateral Internal Thoracic Artery Grafting: Is the Risk Justified?
Giuseppe Gatti1, Luca Maschietto1, Bernardo Benussi1
1Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
Insights
Bilateral internal thoracic artery (BITA) grafting can be safely performed in emergency coronary artery bypass surgery. While BITA grafting showed increased bleeding risk, it did not elevate hospital mortality or other complications compared to single internal thoracic artery (SITA) grafting.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Bilateral internal thoracic artery (BITA) grafting is often limited in emergency surgeries due to risks of ischemia, bleeding, and longer operation times.
- The study addresses the feasibility and outcomes of BITA grafting in urgent coronary artery bypass grafting (CABG) procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of BITA grafting compared to single internal thoracic artery (SITA) grafting in emergency isolated coronary bypass surgery.
- To analyze operative data, hospital mortality, postoperative complications, and long-term outcomes.
Main Methods:
- Retrospective analysis of 4,525 patients undergoing isolated CABG from 1999 to 2015.
- Comparison of 52 patients who received BITA grafting versus 46 patients who received SITA grafting in emergency settings (defined as surgery within one working day of decision).
- Propensity score (PS)-matched analysis was conducted to control for baseline differences.
Main Results:
- No significant difference in hospital mortality between BITA and SITA groups, both overall and in the PS-matched cohort.
- BITA grafting was associated with increased bleeding risk (overall and PS-matched), but not significantly higher rates of blood transfusion or re-exploration.
- Operative duration was slightly increased in the BITA group, though not statistically significant (p=0.12).
- Freedom from major adverse cardiac and cerebrovascular events was trended higher in the PS-matched BITA group (p=0.11).
Conclusions:
- Bilateral internal thoracic artery (BITA) grafting is a viable option for emergency coronary artery bypass surgery.
- BITA grafting does not increase hospital mortality or other postoperative complications besides bleeding when compared to single internal thoracic artery (SITA) grafting.
- Long-term outcomes appear to favor BITA grafting, suggesting potential benefits despite increased surgical urgency.
Abstract:
Background The frequent need of immediate institution of cardiopulmonary bypass because of ischemia and increased risk of bleeding and longer duration of surgery limit the use of bilateral internal thoracic artery (BITA) grafting in urgency. Patients and Methods Of 4,525 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery at the authors' institution (1999-September 2015), 121 (2.7%) patients had an operation before the beginning of the next working day after decision to operate, which is the definition for emergency according to the European System for Cardiac Operative Risk Evaluation II. BITA and single internal thoracic artery (SITA) grafting were used in 52 and 46 of these patients, respectively; venous grafts alone were used in the remaining cases. BITA and SITA patients were compared as risk profiles, operative data, and outcomes. A propensity score (PS)-matched analysis was also performed. Results Between BITA and SITA patients, there was no significant difference as hospital mortality, both in the overall (3.8 vs. 6.5%; p = 0.66) and the PS-matched series (0 vs. 4.3%; p = 1). Among the postoperative complications, only bleeding (but not blood transfusion nor mediastinal re-exploration) was increased both in the overall (p = 0.037) and the PS-matched series of BITA patients (p = 0.092); duration of surgery was increased but not quite significantly (p = 0.12). Freedom from cardiac and cerebrovascular deaths, and major adverse cardiac and cerebrovascular events were higher in PS-matched BITA patients, even though not quite significantly (p = 0.11 for both). Conclusion BITA grafting may be performed even in urgency. With respect to SITA grafting, hospital mortality and postoperative complications other than bleeding are not increased; late outcomes seem to be better.
