虚血性心疾患バイパス術における両側内胸動脈グラフト留置術：35年間の経験

The study objectives were to analyze trends in bilateral internal thoracic artery grafting during isolated coronary artery bypass grafting over a 35-year interval and compare outcomes between bilateral internal thoracic artery and non-bilateral internal thoracic artery strategies.

A cohort of 15,991 patients underwent isolated multivessel coronary artery bypass grafting at our institution between 1990 and 2024. Trends in bilateral internal thoracic artery, radial artery, and left internal thoracic artery + saphenous vein graft were assessed using chi-square tests with Bonferroni correction. Changes in obesity and diabetes prevalence across intervals were also analyzed. Propensity score matching (1:1) yielded 2013 pairs for outcome comparisons between bilateral internal thoracic artery and non-bilateral internal thoracic artery groups.

Between 1990 and 2024, use of bilateral internal thoracic artery and radial artery increased (11.0% and 13.2%, respectively), although bilateral internal thoracic artery declined during 2020 to 2024 as radial artery and left internal thoracic artery + saphenous vein graft use increased. This decline was unrelated to rising obesity or diabetes rates. Matched analysis revealed longer operative times for bilateral internal thoracic artery (+51 minutes, P < .001), whereas cardiopulmonary bypass and crossclamp durations remained similar. Wound-healing complication rates did not increase with bilateral internal thoracic artery grafting. Kaplan-Meier analysis showed superior 30-year survival for bilateral internal thoracic artery compared with other grafting strategies.

Bilateral internal thoracic artery grafting remains underused, particularly in recent years, despite demonstrated survival benefits and comparable wound-healing risks. The decline is not explained by patient risk factors, highlighting the need for broader adoption of bilateral internal thoracic artery grafting and further randomized trials to optimize coronary artery bypass grafting strategies.