title: Off-pump bilateral skeletonized internal thoracic artery grafting in patients with chronic kidney disease.
abstract: BACKGROUND
  We compared the outcomes in propensity score-matched patients who had chronic kidney disease (CKD) undergoing off-pump coronary bypass grafting, with either a bilateral or single skeletonized internal thoracic artery (ITA).
  
  
  METHODS
  Of 1254 consecutive patients undergoing isolated coronary bypass surgery (1248 by the off-pump technique without emergent conversion to cardiopulmonary bypass), the 1203 who received a skeletonized, single (n = 453) or bilateral (n = 750), ITA graft were enrolled, after excluding the 6 patients who received preoperative percutaneous cardiopulmonary support and the 75 who had only 1 target vessel in the left coronary area. A total of 412 pairs were matched using propensity scores. Kaplan-Meier analyses were used to assess all-cause and cardiac-related mortality, by CKD stage (assessed by glomerular filtration rate [GFR]: <30; 30-60; >60 mL/minute/1.73 m(2)). Multivariate Cox proportional hazard models were used to assess for association of bilateral grafting with mortality. A test for interaction of bilateral ITA grafting and estimated GFR was conducted.
  
  
  RESULTS
  No significant difference was found in the incidence of 30-day mortality, stroke, or deep sternal infection between the 2 groups. Although an advanced stage of CKD decreased overall survival, a benefit of bilateral ITA grafting for all-cause and cardiac-related mortality occurred relatively early in the follow-up period and was not influenced by CKD stage. Bilateral ITA grafting was independently associated with a lower risk of both all-cause and cardiac-related mortality in patients with an estimated GFR of <60. No interaction was found between bilateral ITA grafting and estimated GFR in either model.
  
  
  CONCLUSIONS
  In patients who have CKD, off-pump, skeletonized, left-side bilateral ITA grafting is associated with lower risk of all-cause and cardiac-related mortality, and does not increase operative risk.
authors.affiliation: Division of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Japan. Electronic address: kinotakekinotake@yahoo.co.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kinoshita
authors.affiliation: Division of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Asai
authors.affiliation: Division of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D007564:Japan; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: arterial graft; chronic kidney disease; coronary artery bypass graft; off-pump surgery; propensity score