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Related Experiment Videos

Does it make sense to use two internal thoracic arteries?

E Berreklouw1, J P Schönberger, H Ercan

  • 1Department of Cardio-thoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.

The Annals of Thoracic Surgery
|June 1, 1995
PubMed
Summary

Using bilateral internal thoracic arteries (BITA) versus a single left internal thoracic artery (LITA) showed no significant difference in long-term cardiac event-free survival. Both surgical approaches demonstrated comparable outcomes and complication rates over an 8-year follow-up period.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Surgery Outcomes

Background:

  • Internal thoracic arteries are crucial for coronary artery bypass grafting.
  • Bilateral internal thoracic artery (BITA) grafting is an alternative to single LITA, but long-term comparative data is limited.
  • Understanding the long-term efficacy and safety of BITA versus LITA is essential for surgical decision-making.

Purpose of the Study:

  • To compare the long-term outcomes of coronary artery bypass grafting using bilateral internal thoracic arteries (BITA) versus a single left internal thoracic artery (LITA).
  • To evaluate differences in survival rates, cardiac events, and complications between the two surgical techniques over an 8-year follow-up.
  • To identify predictors of adverse cardiac events and recurrent angina in patients undergoing coronary artery bypass grafting.

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Main Methods:

  • Retrospective matched-pair analysis of 143 patients in the BITA group and 143 patients in the LITA group.
  • Follow-up for a maximum of 8 years, assessing event-free survival, overall survival, cardiac survival, angina-free survival, infarction-free survival, reintervention-free survival, and all cardiac event-free survival.
  • Cox proportional hazards analysis was used to identify predictors of recurrent angina and late cardiac events.

Main Results:

  • No significant differences were observed in event-free survival at 5 years between the BITA and LITA groups.
  • At 8 years, while overall and cardiac survival were high in both groups (96% vs. 92% and 99% vs. 97%, respectively), angina-free cardiac survival (51% vs. 35%) and all cardiac event-free survival (49% vs. 31%) showed non-significant trends favoring BITA.
  • The incidence of late pulmonary, wound, and other complications was comparable between the BITA and LITA groups. Higher left ventricular end-diastolic pressure and female sex were identified as predictors of recurrent angina and late cardiac events.

Conclusions:

  • During intermediate-term follow-up (up to 8 years), the use of bilateral internal thoracic arteries (BITA) compared to a single left internal thoracic artery (LITA) did not significantly improve angina-free or cardiac event-free survival.
  • Both BITA and LITA grafting demonstrated comparable long-term safety profiles with similar complication rates.
  • Surgical strategy (BITA vs. LITA) was not a predictor of angina-free or cardiac event-free survival in this cohort.