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Long-Term Outcomes in Coronary Artery Bypass Graft Patients Using Internal Thoracic Artery with Ipsilateral

Yung-Szu Wu1, Shih-Rong Hsieh1,2, Hao-Ji Wei1,2

  • 1Department of Cardiovascular Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung.

Acta Cardiologica Sinica
|August 3, 2019
PubMed

Insights

Coronary artery bypass grafting (CABG) using internal thoracic artery (ITA) grafts in hemodialysis patients with arteriovenous vascular access shows improved outcomes. ITA CABG is associated with a lower risk of death compared to non-ITA CABG.

Area of Science:

  • Cardiovascular Surgery
  • Nephrology
  • Vascular Access

Background:

  • Evaluating long-term outcomes of coronary artery bypass grafting (CABG) in hemodialysis (HD) patients with arteriovenous (AV) fistulae or grafts.
  • Assessing the impact of internal thoracic artery (ITA) graft use on mortality in this specific patient population.

Purpose of the Study:

  • To compare the long-term results of CABG using ITA grafts in HD patients with ipsilateral or contralateral AV vascular access (AVVA).
  • To determine if ITA graft use in CABG impacts survival rates in end-stage renal disease (ESRD) patients with AVVA.

Main Methods:

  • A cohort of 76 ESRD patients undergoing CABG with AVVA between March 2007 and May 2017 were analyzed.
  • Patients were divided into three groups: ITA graft ipsilateral to AVVA (Group A), contralateral ITA graft (Group B), and no ITA graft (Group C).
  • The primary endpoint was all-cause mortality, with an average follow-up of 34.4 months.

Main Results:

  • All-cause mortality was 26.09% in Group A, 36.36% in Group B, and 58.62% in Group C (p=0.04).
  • No significant difference in death rate was observed between ipsilateral and contralateral ITA graft groups.
  • Patients receiving ITA CABG demonstrated a significantly lower risk of death (HR 0.41, p=0.015) compared to those without ITA grafts.

Conclusions:

  • Ipsilateral ITA graft use in CABG for HD patients with AVVA does not increase mortality risk compared to contralateral use.
  • The utilization of ITA grafts in CABG is associated with improved long-term outcomes in hemodialysis patients.
Abstract

Keywords:
Chronic renal failureCoronary artery bypass graftSteal phenomenonUremia

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