Does off-pump bilateral internal thoracic artery grafting increase operative risk in dialysis patients?
BACKGROUND
We compared short-term outcomes of patients with chronic dialysis receiving bilateral internal thoracic artery (BITA) grafting with single internal thoracic artery (SITA) grafting using propensity score analysis.


METHODS
Between 2002 and 2008, 656 consecutive patients underwent isolated coronary artery bypass grafting (99.1% off-pump). Of these, 56 patients with chronic dialysis and multivessel disease were retrospectively compared according to surgical technique, BITA (n = 32) or SITA (n = 23) grafting. In an attempt to minimize the selection bias, propensity scores were created based on 13 preoperative factors (C statistics, 0.914).


RESULTS
There was no significant difference in age, left ventricular ejection fraction, prevalence of diabetes mellitus, and logistic euroSCORE between the 2 groups. All patients underwent revascularization using the off-pump technique without conversion to cardiopulmonary bypass. All arterial conduits were harvested using skeletonization technique. Except for 1 patient, all ITAs were used as in situ graft. Complete revascularization was achieved in all patients. There was no significant difference in occurrence of mediastinitis, impaired wound healing, and stroke between the 2 groups. The 30-day mortality was 6.3% in the BITA group and 13.0% in the SITA group (P = .64). After adjusting for propensity score, BITA grafting was not associated with impaired wound healing (odds ratio, 0.63; 95% confidence interval, 0.04 to 8.79; P = .73) and 30-day mortality (odds ratio, 0.60; 95% confidence interval, 0.05 to 6.82; P = .68).


CONCLUSIONS
In situ skeletonized BITA grafting is safe and feasible in dialysis patients with multivessel disease.
Kinoshita
Takeshi
T
Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Ohtsu, Shiga, Japan. kinotake@belle.shiga-med.ac.jp
Asai
Tohru
T
Hosoba
Soh
S
Takashima
Noriyuki
N
Nishimura
Osamu
O
Hiramatsu
Norihiko
N
Suzuki
Tomoaki
T
Kambara
Atsushi
A
Matsubayashi
Keiji
K
D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome