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Bilateral Internal Thoracic Artery Grafting in Hemodialysis Patients

Kohei Hachiro1, Takeshi Kinoshita1, Tomoaki Suzuki1

  • 1Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science.

Circulation Journal : Official Journal of the Japanese Circulation Society
|June 28, 2021
PubMed

Insights

Bilateral internal thoracic artery grafting in hemodialysis patients did not worsen outcomes but did reduce stroke rates. This technique may be beneficial when other grafts are limited.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Surgery Outcomes

Background:

  • Hemodialysis (HD) patients undergoing isolated coronary artery bypass grafting (CABG) for multivessel disease present unique challenges.
  • The choice between bilateral internal thoracic artery (BITA) and single internal thoracic artery (SITA) grafting impacts postoperative outcomes.
  • Optimizing surgical strategy in HD patients is crucial for improving long-term results and reducing complications.

Purpose of the Study:

  • To compare postoperative outcomes in hemodialysis patients after isolated CABG using BITA versus SITA grafting.
  • To evaluate the safety and efficacy of BITA grafting in this specific patient population.
  • To determine if BITA grafting is associated with improved or worsened mid-term survival and complication rates.

Main Methods:

  • Retrospective analysis of 145 hemodialysis patients who underwent isolated CABG between 2002 and 2020.
  • Application of inverse probability of treatment weighting (IPTW) to balance preoperative characteristics between BITA and SITA groups.
  • Comparison of 30-day mortality, deep sternal wound infection, stroke rates, and freedom from all-cause and cardiac death.

Main Results:

  • No significant differences were observed in 30-day mortality or deep sternal wound infection between BITA and SITA groups.
  • The BITA group demonstrated a significantly lower postoperative stroke rate (0% vs. 4.0%, P=0.019).
  • Multivariate analysis revealed no association between BITA grafting and improved or worsened mid-term all-cause or cardiac death.

Conclusions:

  • Bilateral internal thoracic artery grafting in hemodialysis patients undergoing CABG does not appear to compromise mid-term outcomes.
  • BITA grafting was associated with a reduced incidence of postoperative stroke in this cohort.
  • BITA grafting may be a valuable option for patients with limited conduit availability, potentially mitigating postoperative complications.
Abstract

Keywords:
Coronary artery bypass graftingDeep sternal wound infectionHemodialysis

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