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[The propriety of bilateral internal thoracic artery grafting in women]
K Kamohara1, R Sakata, Y Nakayama
1Department of Cardiovascular Surgery, Kumamoto Central Hospital, Japan.
Insights
Bilateral internal thoracic artery (BITA) grafting is a safe and effective option for coronary artery bypass grafting (CABG) in women, showing similar outcomes to men. Exclusion criteria focus on preoperative risk factors.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
- Bilateral internal thoracic artery (BITA) grafting offers potential advantages over single internal thoracic artery (SITA) grafting.
- The suitability of BITA grafting in female patients requires specific evaluation.
Purpose of the Study:
- To evaluate the propriety and clinical outcomes of BITA grafting in female patients undergoing CABG.
- To compare the outcomes of BITA grafting in women with those of SITA grafting in women.
- To compare the outcomes of BITA grafting in women with those of BITA grafting in men.
Main Methods:
- Retrospective comparison of clinical outcomes.
- Group B-F: 50 women undergoing BITA grafting.
- Group S: 50 women undergoing SITA grafting.
- Group B-M: 50 men undergoing BITA grafting.
Main Results:
- No significant differences in postoperative complications or mortality between BITA and SITA in women.
- No significant differences in preoperative factors, intraoperative details, or postoperative outcomes between female and male BITA recipients, except for body size.
- Graft patency rates were similar between groups.
Conclusions:
- BITA grafting is a viable and safe option for CABG in female patients, comparable to male patients.
- Exclusion criteria for BITA grafting should focus on identified preoperative risk factors.
- BITA grafting can be considered a conduit of choice for both female and male CABG patients.
Abstract:
In our institution, the exclusion criteria of the bilateral internal thoracic artery (BITA) grafting include age over 70 years old, obesity, severe diabetes, renal dysfunction and poor preoperative physical activity. The objective of this study is to evaluate propriety of the use of bilateral internal thoracic artery for coronary artery bypass grafting (CABG) in women. Clinical outcome of female patients who underwent BITA grafting (group B-F; n = 50) was compared with that of female patients who underwent single internal thoracic artery grafting (group S; n = 50). In addition, clinical outcome of the male patients who underwent BITA grafting (group B-M; n = 50) was compared with that of group B-F. Between group B-F and S, the age, prevalence of obesity and that of renal dysfunction were significantly different, which was predictable because of the group selection according to the criteria. However, the prevalence of previous myocardial infarction and that of left ventricular dysfunction and the extent of coronary artery disease were not significantly different. Whereas, between group B-F and B-M, preoperative factors were not significantly different except the body size. Intraoperative technical factors, such no of grafts, aortic cross clamp time, cardiopulmonary bypass time, rate of complete revascularization, were not significantly different. In comparison of group B-F with group B-M, the site of anastomosis with arterial grafts were not significantly different. Patency rate of arterial and venous grafts two week after operation was not significantly different. Either postoperative complications, such as reoperation for bleeding, wound complication, low output syndrome, renal dysfunction etc, were not significantly different. One patient (2%) in group B-F and 1 patient (2%) in group B-M died in the hospital (p > 0.05). In summary, BITA can be a viable conduit of choice for CABG in female patients as well as that in male patients. Criteria of the use of BITA is recommended to exclude preoperative risk factors above-mentioned.