Off-pump bilateral internal thoracic artery grafting in right internal thoracic artery to right coronary system.
BACKGROUND
Despite many large-volume studies on the use of bilateral internal thoracic artery (ITA) grafts, the benefits of a bilateral (B)ITA graft over a single (S)ITA graft for CABG remain controversial. This study compared midterm outcomes of BITA to SITA grafting in off-pump coronary artery bypass (OPCAB), focusing primarily on the right (R)ITA to right coronary artery (RCA) system.


METHODS
From January 2000 to December 2009, 1,749 patients underwent isolated OPCAB with ITA grafts. Using propensity score matching, 366 BITA patients could be pairwise propensity matched to a SITA patient. We compared midterm survival and major adverse cardiac and cerebrovascular event (MACCE) between the 2 groups. All patients in the BITA group underwent bilateral ITA grafting with the RITA anastomosed to the RCA system. Mean follow-up was 84.46±24.47 months (range, 5 to 120 months).


RESULTS
Overall survival at 10 years was not significantly different between the 2 groups (84.6% vs 84.1%; p=0.955). The 10-year cardiac-related death-free rate also did not significantly differ between the groups (90.0% vs 90.9%; p=0.871). The 10-year MACCE-free rate did not significantly differ between the 2 groups (79.7% vs 74.6%; p=0.303).


CONCLUSIONS
At 10-year follow-up, BITA grafting did not offer advantages over SITA grafting in midterm outcomes, at least in the RITA to RCA system. The BITA grafting was similar to SITA grafting in overall and cardiac survival, and MACCE rates.
Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.
Hyun-Chel
HC
Joo
Young-Nam
YN
Youn
Gijong
G
Yi
Byung-Chul
BC
Chang
Kyung-Jong
KJ
Yoo
D000704:Analysis of Variance; D015331:Cohort Studies; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods* / Q000401:mortality*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods* / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008323:Mammary Arteries / Q000601:surgery / Q000637:transplantation*; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011859:Radiography; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome