Bilateral Internal Thoracic Artery Grafts in Hemodialysis: A Single-Center Propensity Score Analysis

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Surgical Outcomes Research

Background:

• Limited clinical evidence exists comparing bilateral internal thoracic artery (BITA) and single internal thoracic artery (SITA) grafts for coronary artery bypass grafting (CABG) in hemodialysis patients.
• Understanding the surgical risk and long-term effectiveness of these grafting techniques is crucial for this high-risk population.

Purpose of the Study:

• To compare the short-term and midterm outcomes of CABG using BITA versus SITA grafts in patients undergoing maintenance hemodialysis.
• To evaluate the safety and efficacy of BITA grafting in hemodialysis patients requiring coronary revascularization.

Main Methods:

• A retrospective study included 161 hemodialysis patients who underwent isolated CABG between 2000 and 2015.
• 67 patients received BITA grafts and 94 received SITA grafts.
• Propensity score matching created 59 comparable pairs of BITA and SITA recipients for analysis.

Main Results:

• No significant differences were observed in 30-day mortality, deep sternal wound infection, stroke, or respiratory failure between BITA and SITA groups.
• Kaplan-Meier survival analysis showed comparable rates at 1, 3, and 5 years post-CABG.
• There were no statistically significant differences in overall survival, freedom from cardiac death, or freedom from cardiac events between the two groups.

Conclusions:

• Coronary artery bypass grafting with BITA grafts did not demonstrate superior midterm outcomes compared to SITA grafts in hemodialysis patients.
• BITA grafting was not associated with increased perioperative morbidity or mortality in this cohort.
• BITA grafting represents a valuable option for multivessel revascularization in hemodialysis patients, particularly when other conduit options are limited.