Double versus single source left-sided coronary revascularization using bilateral internal thoracic artery graft
Giuseppe Gatti1, Gianluca Castaldi2, Marco Morosin2
1Cardiovascular Department, Ospedale di Cattinara, University Hospital of Trieste, via Pietro Valdoni, 7, 34148, Trieste, Italy. gius.gatti@gmail.com.
Heart and Vessels
|August 13, 2017
Summary
Bilateral internal thoracic artery (BITA) grafts for left-sided coronary revascularization show similar long-term outcomes regardless of in situ or Y-graft configuration. This finding holds true even after stress testing, indicating configuration independence for BITA grafts.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Left-sided coronary revascularization frequently utilizes bilateral internal thoracic artery (BITA) grafts.
- These grafts are typically configured as either in situ (double source) or Y-graft (single source).
- The choice of configuration may influence patient outcomes, though evidence is limited.
Purpose of the Study:
- To compare the clinical outcomes of left-sided coronary revascularization using skeletonized BITA grafts in either in situ or Y-graft configurations.
- To evaluate the impact of BITA graft configuration on short-term and long-term patient results, including cardiac death, major adverse cardiac and cerebrovascular events (MACCEs), and repeat revascularization.
- To assess functional capacity through cardiopulmonary exercise testing in a subset of matched patients.
Main Methods:
- A retrospective analysis of 253 patients undergoing isolated left-sided coronary revascularization with BITA graft alone (2000-2015).
- Patients received either skeletonized in situ (n=199) or Y-graft (n=54) BITA configurations.
- Propensity score matching was used to create comparable groups (40 pairs) for outcome analysis. Cardiopulmonary exercise testing was performed in five matched pairs.
Main Results:
- Unmatched BITA Y-graft patients had higher in-hospital mortality and postoperative complications compared to in situ BITA patients.
- These differences were not significant in the propensity score-matched groups.
- Long-term follow-up (mean 5.9 years) revealed no significant differences in freedom from cardiac death, MACCEs, or repeat coronary revascularization between matched in situ and Y-graft BITA configurations.
- Cardiopulmonary exercise testing showed no significant functional differences between configurations.
Conclusions:
- The configuration of bilateral internal thoracic artery (BITA) grafts (in situ vs. Y-graft) does not significantly impact the long-term outcomes of left-sided coronary revascularization.
- Results are independent of the BITA configuration, even when assessed by functional capacity via stress testing.
- This suggests that either configuration can be safely employed for left-sided coronary revascularization with BITA grafts alone.
