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Bilateral internal thoracic artery versus single internal thoracic artery plus radial artery: A double meta-analytic

Stefano Urso1, Rafael Sadaba2, Jesús María González Martín3

  • 1Cardiac Surgery Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain.

The Journal of Thoracic and Cardiovascular Surgery
|April 19, 2022
PubMed

Insights

Bilateral internal thoracic artery (BITA) grafting offers a survival advantage over single internal thoracic artery plus radial artery after 10 years in coronary surgery. This benefit is not observed within the first decade post-operation.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Medical Research Methodology

Background:

  • Investigating optimal graft selection for coronary artery bypass grafting (CABG) is crucial for long-term patient outcomes.
  • The use of bilateral internal thoracic artery (BITA) versus single internal thoracic artery (SITA) combined with a radial artery (RA) graft is a subject of ongoing debate.

Discussion:

  • This study performed a double meta-analysis of propensity score-matched or adjusted studies to compare BITA and SITA+RA in CABG.
  • The analysis focused on long-term mortality as the primary endpoint, utilizing both generic inverse variance and Kaplan-Meier-derived individual patient data methods.

Key Insights:

  • BITA grafting demonstrated a statistically significant survival benefit after 10 years compared to SITA+RA (HR 0.77, P=0.01).
  • No significant survival difference was detected between the two grafting strategies within the first 10 years post-surgery (HR 0.99, P=0.93).
  • Survival estimates at 15 years favored BITA (68.0%) over SITA+RA (63.9%).

Outlook:

  • The findings suggest that BITA may be a superior choice for long-term survival in CABG patients.
  • Further research could explore the specific mechanisms behind the delayed survival benefit of BITA grafts.
  • Consideration of BITA grafting for younger patients or those anticipating long-term survival may be warranted.
Abstract

Keywords:
Kaplan-Meier analysisbilateral internal mammary arterycoronary artery bypass graftingmeta-analysisradial arterysurvival

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