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Improved survival with multiple left-sided bilateral internal thoracic artery grafts
S E Schmidt1, J W Jones, J I Thornby
1Baylor College of Medicine, Houston, Texas, USA.
The Annals of Thoracic Surgery
|July 1, 1997
Summary
Grafting both internal thoracic artery (ITA) bypass grafts to left-sided coronary arteries significantly improves long-term survival in patients undergoing bilateral ITA operations compared to traditional grafting. This strategy maximizes clinical benefits by targeting arteries supplying more left ventricular muscle.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Coronary Artery Bypass Grafting
Background:
- Bilateral internal thoracic artery (ITA) bypass grafting is used to improve long-term outcomes, but optimal graft configuration is debated.
- Traditional bilateral ITA operations involve grafting to the left anterior descending and right coronary arteries.
- Previous studies have not compared outcomes based on specific coronary artery targets for bilateral ITA grafts.
Purpose of the Study:
- To compare the long-term clinical outcomes of patients undergoing bilateral ITA operations with different graft configurations.
- To determine if directing both ITA grafts to left-sided coronary arteries improves survival compared to traditional grafting.
Main Methods:
- A single-surgeon, 10-year experience of 498 consecutive bilateral ITA operations was analyzed.
- Patients were divided into two groups: Group I (traditional: left ITA to LAD, right ITA to RCA) and Group II (left ITA to circumflex, right ITA to LAD).
- Follow-up averaged 7.1 years with 94.2% completeness; survival was analyzed using Kaplan-Meier estimates and multivariate analysis.
Main Results:
- Operative morbidity and mortality were similar between groups; ITA conduit patency rates were also equivalent (91.7% vs 89.6%).
- Multivariate analysis revealed that ITA graft location significantly influenced survival (p=0.0288), independent of gender.
- Kaplan-Meier analysis showed significantly improved survival in Group II (both ITA grafts to left-sided arteries) compared to Group I (p=0.021), with curves diverging at 6 years.
Conclusions:
- Maximum long-term benefit from bilateral ITA operations is achieved by grafting to coronary arteries supplying more left ventricular muscle.
- Directing both ITA bypass grafts to left-sided coronary arteries represents an optimal configuration for enhanced patient survival.
- This strategy may lead to better functional status, although not statistically significant in this cohort.
