Off-pump bilateral internal thoracic artery grafting in patients with left main coronary artery disease
Kohei Hachiro1, Noriyuki Takashima2, Tomoaki Suzuki2
1Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, 520-2192, Shiga, Japan. starplatinum.1140@gmail.com.
Insights
Bilateral skeletonized internal thoracic artery (ITA) grafting improves long-term survival and reduces major adverse cardiac events compared to single ITA grafting in patients with left main coronary artery disease. This off-pump coronary artery bypass grafting technique offers superior outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery Outcomes
Background:
- Left main coronary artery disease (LMCD) poses significant risks.
- Off-pump coronary artery bypass grafting (CABG) is a common surgical approach.
- Internal thoracic artery (ITA) grafting is crucial for CABG procedures.
Purpose of the Study:
- To compare postoperative outcomes of skeletonized bilateral ITA versus single ITA grafting.
- To evaluate the efficacy of different ITA grafting strategies in LMCD patients.
- To assess long-term survival and major adverse cardiac and cerebrovascular events (MACCE).
Main Methods:
- Retrospective analysis of 1583 isolated CABG patients (2002-2022).
- Focus on 604 LMCD patients undergoing single (n=169) or bilateral (n=435) ITA grafting.
- Inverse probability of treatment weighting (IPTW) used for adjusting preoperative characteristics.
Main Results:
- No significant difference in deep sternal wound infection or 30-day mortality.
- At 10-year follow-up, bilateral ITA grafting showed improved overall survival (71.2% vs 60.6%) and MACCE-free survival (63.3% vs 46.3%).
- Multivariate analysis revealed bilateral ITA grafting significantly lowered the risk of all-cause death (HR: 0.706) and MACCE (HR: 0.671).
Conclusions:
- Bilateral skeletonized ITA grafting is associated with superior long-term survival.
- This technique significantly reduces the risk of MACCE in LMCD patients.
- Bilateral ITA grafting represents an advantageous strategy for off-pump CABG in LMCD.
Background:
To compare postoperative outcomes in patients with left main coronary artery disease who underwent off-pump isolated coronary artery bypass grafting for multivessel disease using either skeletonized bilateral or single internal thoracic artery (ITA).
Methods:
Among 1583 patients who underwent isolated coronary artery bypass grafting (CABG) in our hospital between 2002 and 2022, 604 patients with left main coronary artery disease underwent single (n = 169) or bilateral (n = 435) ITA grafting. We compared postoperative outcomes between the two groups after adjusting preoperative characteristics using inverse probability of treatment weighting.
Results:
After adjustment using inverse probability of treatment weighting method, the sum of weights was 599.74 in BITA group and 621.64 in SITA group. There was no significant difference in postoperative deep sternal wound infection (p = 0.227) and 30-day mortality (p = 0.612). Follow-up was completed in 98.7% (596/604) of the patients, and the mean follow-up duration was 6.7 years. At 10 years, the overall survival following bilateral versus single ITA grafting was 71.2% and 60.6%, respectively (log-rank test, p = 0.040), and freedom from major adverse cardiac and cerebrovascular events (MACCE) was 63.3% and 46.3%, respectively (log-rank test, p = 0.008). In multivariate Cox proportional hazard models, bilateral ITA grafting was significantly associated with a lower risk of all-cause death (hazard ratio [HR]: 0.706, 95% confidence interval [CI]: 0.504-0.987; p = 0.042) and MACCE (HR: 0.671, 95% CI: 0.499-0.902; p = 0.008).
Conclusions:
Bilateral skeletonized ITA grafting is associated with lower rates of all-cause death and MACCE than single ITA grafting in patients with left main coronary artery disease undergoing off-pump CABG.
