title: Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience.
abstract: IntroductionMultivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses.Material and MethodsThe department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with ap< 0.3 at univariate analysis.ResultsBetween January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3-9.9 and OR: 5.4, 95% CI: 1.3-21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n= 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%,p= 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2-33.5), that was unfailingly due to ungraftable right coronary artery targets.DiscussionBITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.
authors.affiliation: Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France.
authors.forename: Andrea
authors.initials: A
authors.lastname: Perrotti
authors.affiliation: Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Spina
authors.affiliation: Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France.
authors.forename: Enrica
authors.initials: E
authors.lastname: Dorigo
authors.affiliation: Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Durst
authors.affiliation: Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France.
authors.forename: Djamel
authors.initials: D
authors.lastname: Kaili
authors.affiliation: Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France.
authors.forename: Sidney
authors.initials: S
authors.lastname: Chocron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D016009:Chi-Square Distribution; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D005602:France; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome