title: Routine use of bilateral internal thoracic artery grafting in women: A risk factor analysis for poor outcomes.
abstract: BACKGROUND
  Concerns about increased risk of postoperative complications, primarily deep sternal wound infection (DSWI), prevent liberal use of bilateral internal thoracic artery (BITA) grafting in women. Consequently, outcomes after routine BITA grafting remain largely unexplored in female gender.
  
  
  METHODS
  Of 786 consecutive women with multivessel coronary disease who underwent isolated coronary bypass surgery at the authors' institution from 1999 throughout 2014, 477 (60.7%; mean age: 70±7.7years) had skeletonized BITA grafts; their risk profiles, operative data, hospital mortality and postoperative complications were reviewed retrospectively. Risk factor analysis for hospital death, DSWI and poor late outcomes were performed by means of multivariable models.
  
  
  RESULTS
  There were 19 (4%) hospital deaths (mean EuroSCORE II: 5.2±6.1%); glomerular filtration rate<50ml/min was an independent risk factor (p=0.035). Prolonged invasive ventilation (11.3%), multiple blood transfusion (12.1%) and DSWI (10.7%) were most frequent major postoperative complications. Predictors of DSWI were body mass index >35kg/m2(p=0.0094), diabetes (p=0.005), non-elective surgical priority (p=0.0087) and multiple blood transfusions (p=0.016). The mean follow-up was 6.8±4.5years. The non-parametric estimates of the 13-year freedom from cardiac and cerebrovascular deaths, major adverse cardiac and cerebrovascular events, and repeat myocardial revascularization were 76.1 [95% confidence interval (CI): 73.1-79.1], 59.5 (95% CI: 55.9-63.1) and 91.9% (95% CI: 90.1-93.7), respectively. Preoperative congestive heart failure (p=0.04) and left main coronary artery disease (p=0.0095) were predictors of major adverse cardiac and cerebrovascular events.
  
  
  CONCLUSIONS
  BITA grafting could be performed routinely even in women. The increased rates of early postoperative complications do not prevent excellent late outcomes.
authors: CardioVascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy. Electronic address: gius.gatti@gmail.com.
authors: Giuseppe
authors: G
authors: Gatti
authors: CardioVascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors: Luca
authors: L
authors: Maschietto
authors: CardioVascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors: Marco
authors: M
authors: Morosin
authors: CardioVascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors: Marco
authors: M
authors: Russo
authors: CardioVascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors: Bernardo
authors: B
authors: Benussi
authors: CardioVascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors: Gabriella
authors: G
authors: Forti
authors: CardioVascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors: Lorella
authors: L
authors: Dreas
authors: CardioVascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors: Gianfranco
authors: G
authors: Sinagra
authors: CardioVascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors: Aniello
authors: A
authors: Pappalardo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000401:mortality; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Arterial grafts; Coronary artery bypass grafts; Gender; Outcomes