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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Bilateral internal thoracic artery use in coronary bypass surgery: is there a benefit?
Jeremy R Leonard1, Ahmed A Abouarab1, David P Taggart2
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th St, M-404, New York, NY 10065 USA.
Insights
Bilateral internal thoracic arteries (BITA) show improved outcomes in meta-analyses compared to saphenous vein grafts (SVG). However, recent trials question BITA
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes Research
Background:
- Retrospective data and meta-analyses suggest bilateral internal thoracic arteries (BITA) improve outcomes in coronary artery bypass grafting (CABG) compared to saphenous vein grafts (SVG).
- Recent studies challenge the long-held assumptions regarding BITA's superiority.
Purpose of the Study:
- To review existing literature on BITA versus SVG in CABG.
- To clarify the appropriate use of BITA in modern cardiac surgery.
Main Methods:
- Comprehensive review of meta-analyses comparing BITA and SVG in CABG.
- Comparison of findings from large randomized controlled trials (RCTs) with observational data.
Main Results:
- Existing meta-analyses consistently show BITA offers advantages over single internal thoracic artery (SITA) and SVG.
- The two largest RCTs on BITA failed to demonstrate a survival benefit and raised concerns about associated complications.
Conclusions:
- The use of multiple arterial grafts, including BITA, remains a viable option, especially for younger patients, if operative risk is not elevated.
- Ongoing research is expected to provide more definitive evidence on the long-term efficacy and safety of BITA in CABG.
Purpose:
Over the past three decades, there have been a plethora of retrospective observational data and meta-analyses which support the hypothesis of improved clinical outcomes using bilateral internal thoracic arteries (BITA) when compared to saphenous vein grafts (SVGs). However, recently published results have brought this thinking into doubt. We discuss the existing literature on the subject and attempt to clarify the appropriate use of BITA in coronary artery bypass surgery (CABG).
Methods:
A review of all existing meta-analyses on BITA was conducted to better understand the utility of BITA in CABG. A review of the largest randomized controlled trials on the subject was then compared to the observational data.
Results:
In all existing meta-analyses, BITA shows a significant advantage over the use of a single internal thoracic artery (SITA) with SVGs. The two largest randomized controlled trials evaluating BITA failed to show a survival advantage and brought into question the complications associated with BITA.
Conclusions:
At present, the use of multiple arterial grafts remains a reasonable choice, particularly in young patients, provided that their use does not increase the operative risk. Further evidence currently being collected may lend a definitive answer in the near future.
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