Long-Term Performance of Bilateral Internal Thoracic Artery Grafts in Young Adults

OBJECTIVE Coronary artery disease (CAD) in young adults is uncommon but associated with substantial long-term morbidity. Limited evidence exists regarding the long-term outcomes of bilateral internal thoracic artery (BITA) grafting in this population. This study evaluates perioperative and long-term outcomes of BITA revascularization in young adults undergoing coronary artery bypass grafting (CABG) and compares survival outcomes with those of the general population. METHODS A retrospective single-center observational study was conducted in 67 young patients (39 ± 3 years) who underwent BITA grafting for multivessel CAD. Perioperative outcomes, long-term overall survival, major adverse cardio-cerebral events (MACEs), and repeat revascularization were assessed. Long-term outcomes were evaluated using Kaplan-Meier analysis. Further survival analysis was conducted using an age- and sex-adjusted general population matched for age, sex, and calendar year. RESULTS BITA grafting was associated with very low perioperative morbidity. The median follow-up was 17 years, with an estimated overall survival at 20 years of 74% [0.74 (95% confidence interval [CI], 0.52-0.87)] and freedom from MACEs at 20 years of 70% [0.70 (95% CI, 0.49-0.84)]. Sternal wound complications were infrequent (1.5%). CONCLUSIONS BITA revascularization in young adults demonstrates excellent long-term survival, with survival comparable to that of the age- and sex-matched general population during the first 15 years after surgery, along with durable event-free outcomes, supporting its use as a durable revascularization strategy in this population.