Bilateral internal thoracic artery grafting in elderly patients: Any benefit in survival?

Is bilateral internal thoracic artery truly better for older patients?

“…However, in the present study, there was a mixed population in the SITA graft group, which included LITA plus RA with or without saphenous vein (SVG) in 80% of the patients and LITA plus SVG in the remaining patients. 2 Therefore, we are concerned about the difference of outcomes between the BITA and SITA graft groups was derived from these 20% of patients with LITA plus SVG. If the authors can provide an additional subgroup analysis, it would have better clarified the significance of their findings.…”

Reply: Mīlle viae dūcunt hominēs per saecula Rōmam

“…UCUNT HOMIN ES PER SAECULA R OMAM Reply to the Editor: I read with great interest the author's letter based on their article reporting exemplary outcomes using bilateral internal thoracic arteries among elderly patients receiving coronary artery bypass grafting. 1 "M ılle viae d ucunt homin es per saecula R omam" translated from the Latin means "a thousand roads lead men forever to Rome." This phrase likely refers to the "Millarium Aureum," a monument erected by the Emperor Caesar Augustus in central Rome.…”

Commentary: Stronger evidence than Arterial Revascularization Trial in patients aged 70 years or more?

“…1 The subgroup analysis in patients aged 70 years or more in the ART study involved 406 patients with BITA and 426 patients with SITA. The 2 groups should certainly be well balanced for both measured and unmeasured variables because this is a randomized trial, and the sample size was larger than that of the study by Navia and colleagues 5 (243 matched pairs). Of note, there was no difference in terms of death from any cause between the groups (hazard ratio, 0.93; 95% confidence interval, 0.75-1.16) up to 10 years in the ART.…”

“…In this issue of the Journal, Navia and colleagues 5 investigated this issue using their institutional observational data. The study included 1300 patients aged 70 years or older who had undergone CABG using BITA (n ¼ 968) or a single internal thoracic artery (SITA, n ¼ 332).…”

“…However, this confounder does not seem to have been adequately addressed in this comparative study between BITA and SITA. In addition, if the superior survival outcomes were to be purely due to the use of BITA in the study by Navia and colleagues, 5 other outcome indexes such as myocardial infarction and repeat revascularization should have also been in favor of BITA, but were not demonstrated as such.…”