Has Arterial Revascularization Trial [ART] burst the BITA bubble?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Clinical Trials

Background:

• Coronary artery bypass grafting (CABG) is a cornerstone treatment for coronary artery disease.
• Internal thoracic artery (ITA) grafting is preferred for its long-term patency.
• Debate exists regarding the optimal number of ITAs for grafting.

Purpose of the Study:

• To critically appraise the 10-year outcomes of the Arterial Revascularization Trial (ART).
• To compare bilateral internal thoracic artery (BITA) versus single internal thoracic artery (SITA) grafting strategies in CABG.
• To evaluate the impact of BITA grafting on sternal wound infections, learning curve, volume, hospital stay, and quality of life.

Main Methods:

• Review and critical appraisal of the published 10-year results from the Arterial Revascularization Trial (ART).
• Analysis of data comparing BITA versus SITA grafting in a large randomized cohort.
• Discussion of secondary outcomes including surgical complications and patient-reported quality of life.

Main Results:

• The 10-year follow-up of the ART demonstrates superior long-term survival and reduced adverse cardiac events with BITA grafting compared to SITA.
• Analysis addresses the learning curve and surgeon volume as potential factors influencing outcomes.
• No significant increase in sternal wound infection rates was observed with BITA grafting.

Conclusions:

• Bilateral internal thoracic artery grafting represents a safe and effective strategy for coronary artery bypass, offering improved long-term benefits.
• The findings support the routine use of BITA grafting in appropriate patients undergoing CABG.
• Further consideration of BITA grafting is warranted to optimize patient outcomes and quality of life.