Bilateral internal thoracic artery grafting in patients with left main disease: a single-center experience
Amit Gordon1, Nachum Nesher1, Raphael Mohr1
1Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University.
Insights
Bilateral internal thoracic artery (BITA) grafting did not show a clear benefit over single internal thoracic artery (SITA) grafting for patients with left main (LM) disease. Long-term survival favored BITA, but this was not statistically significant after propensity matching.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery Outcomes
Background:
- Left main (LM) disease is a critical condition requiring revascularization.
- Internal thoracic artery (ITA) grafting is a standard surgical approach.
- Comparing bilateral (BITA) versus single (SITA) ITA grafting is essential for optimizing patient outcomes.
Purpose of the Study:
- To compare early and long-term outcomes of BITA versus SITA grafting in patients with LM disease.
- To evaluate the impact of grafting strategy on mortality, morbidity, and survival.
Main Methods:
- Retrospective analysis of 949 BITA and 564 SITA patients with LM disease (1996-2011).
- Multivariate analysis and propensity score matching (477 pairs) were used to adjust for confounding variables.
- Key variables included age, comorbidities, operation type, and graft details.
Main Results:
- No significant differences in 30-day mortality, sternal wound infection, or stroke between SITA and BITA groups.
- BITA patients initially showed improved long-term survival (70.1% vs. 52.0%, p<0.001) over a 15-year median follow-up.
- This survival benefit was not statistically significant after propensity score matching (P = 0.135).
Conclusions:
- This study did not establish a clear early or long-term benefit of BITA grafting over SITA grafting in patients with LM disease.
- The observed survival advantage for BITA grafts was attenuated after statistical adjustment, suggesting other factors may be involved.
Objective:
We compared early and long-term outcomes between bilateral internal thoracic artery (BITA) grafting and single internal thoracic artery (SITA) grafting in patients with LM disease.
Methods:
We evaluated the outcomes of all patients with LM disease who underwent revascularization in our center during 1996-2011. Variables that were adjusted for in a multivariate analysis and in propensity matching included age, sex, comorbid diseases, repeat operation, the number of diseased vessels, other conduits used, the use of sequential grafting, the number of grafts constructed, and the operative era (1996-2000 vs. 2001-2011).
Results:
In total, 949 patients with LM disease underwent BITA grafting and 564 underwent SITA grafting during the study period. SITA patients were more often female and more likely to have comorbidities such as chronic obstructive pulmonary disease, ejection fraction <30%, recent myocardial infarction, diabetes, congestive heart failure, chronic renal failure, and peripheral vascular disease, and to have undergone an emergency operation. We found no statistically significant difference between the SITA and BITA groups in 30-day mortality (4.8% vs. 3.3%, P = 0.136), sternal wound infection (2.0% vs. 2.4%, P = 0.548), and stroke (3.2% vs. 4.4%, P = 0.234). BITA patients had improved long-term survival (70.1% vs. 52.0% p<0.001), median follow-up of 15 years. In multivariate analysis, after propensity score matching (477 matched pairs), this finding was not statistically significant (P = 0.135).
Conclusion:
This study did not demonstrate a clear benefit of BITA grafts among patients with LM disease.
