Bilateral internal thoracic artery grafting: Does graft configuration affect outcome?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Bilateral internal thoracic arteries (ITAs) offer improved long-term survival in coronary artery bypass grafting (CABG).
• However, the adoption of bilateral ITA grafting remains low.
• This study directly compares different bilateral ITA configurations and their long-term outcomes.

Purpose of the Study:

• To compare the long-term outcomes of various bilateral internal thoracic artery (ITA) graft configurations in patients undergoing coronary artery bypass grafting (CABG).
• To determine if specific graft configurations impact mortality or the need for repeat revascularization.

Main Methods:

• A retrospective review of 762 patients who underwent CABG with bilateral ITA grafts between 1997 and 2014.
• Outcomes assessed included mortality and a composite endpoint of repeat revascularization (percutaneous coronary intervention or repeat CABG).
• Propensity score-adjusted Cox proportional hazards modeling was used for adjusted subgroup analyses.

Main Results:

• The study analyzed 4 distinct bilateral ITA graft configurations.
• Over a median follow-up of 1128 days, there were 47 deaths, 58 late percutaneous coronary interventions, and 7 repeat CABG procedures.
• While unadjusted analysis showed a difference in repeat revascularization (P=.049), adjusted analysis revealed no independent effect of graft configuration on repeat revascularization or death.

Conclusions:

• Bilateral ITA graft configuration does not independently influence long-term survival or the need for repeat revascularization after CABG.
• The choice of surgical technique should prioritize simplicity and be tailored to individual patient characteristics.