Does Bilateral ITA Grafting Increase Perioperative Complications? Outcome of 6,476 Patients with Bilateral versus 5,020 Patients with Single ITA Bypass

Abstract

Objectives Despite the superior patency of internal thoracic artery (ITA) grafting compared with saphenous veins, frequency of bilateral ITA (BITA) grafting in Europe is still approximately 10%. The aim of the present study was to compare the early outcome of patients receiving either BITA or single ITA (SITA) grafting. Methods A total of 11,496 patients with isolated coronary artery bypass grafting (CABG), operated between January 1996 and December 2012, were analyzed retrospectively; 0.6476 patients (mean age 65.2 years, 81.3% males) received BITA and 5,020 patients (mean age 66.6 years, 76.7% males) SITA grafting. Mean body mass index (BMI) was 27.2 versus 27.4, p ¼ 0.017. Incidence of diabetes was 28.9 versus 28.4%, p ¼ 0.08. Ejection fraction (EF) > 50 was 71.3% (BITA) versus 66.3% (SITA), p < 0.001. Elective operations were performed in 88.4% (BITA) versus 83.3% (SITA), and urgent/emergent surgery was necessary in 11.6% (BITA) versus 16.7% (SITA), p < 0.001. Results Number of grafts was 3.76 (BITA) versus 3.06, p < 0.001. Duration of surgery (194.4 vs. 180.4 minutes) as well as X-clamp time (60.4 vs. 51.7 minutes) was prolonged for BITA, p < 0.001. Perioperative infarction rate revealed 3.2% (BITA) versus 3.6%, p ¼ 0.54. Frequency of rethoracotomy due to bleeding was higher in the BITA group (3.8 vs. 2.1%), p < 0.001. Sternal instabilities occurred in 2.3% (BITA) versus 2.2%, p ¼ 0.749. Duration of mechanical ventilation < 12 hours was 74.6 versus 77.1%, p ¼ 0.09 and duration of in-hospital stay was 10.5 versus 10.4 days, p ¼ 0.68. Thirty-day mortality was 2.4% (BITA) versus 3.0%, p ¼ 0.09. Multivariate analysis identified prolonged duration of surgery, BMI > 30, emergent operations, advanced age, and BITA grafting as predictor for sternal instabilities. EF < 30%, advanced age plus emergency were associated with increased 30-day mortality. Conclusion CABG using BITA can be performed routinely with good clinical results and low mortality. Compared with SITA grafting, bleeding complications were enhanced.

Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the BYPASS Registry

“…Bilateral internal thoracic arteries (ITA) were used only in 4.8% of the patients, a practice more frequent than that reported by the STS database (4.1%), but fair below the European practice (10%) [22,23] . Only 16.9% of the patients had total arterial graft, of which 69% of the patients received only one ITA graft.…”

Short-term results of bilateral internal mammary arterial grafting for patients aged 60–75 years – a retrospective study

“…The incidence rate of severe sternal wound complications was 0% in Group A and 1.7% in Group B. Although the prevalence of diabetes in Group B was higher than that in Group A, there was no significant difference in the incidence rate of sternal wound complications between these two groups, and the incidence rate of severe sternal wound complications was lower than 2.3–12.8% reported in the literature [11, 12]. Our experience in the prevention of sternal wound complications was as follows.…”

Bilateral Internal Thoracic Artery Grafting Concomitant With Other Cardiac Operations ― Insights From a European Multicenter Retrospective Study on 1,123 Consecutive Patients ―

“…Long-term outcomes were comparable with those of other similar studies in the literature, 28-38 but, as expected, poorer than those for isolated BITA grafting. [5][6][7][8][9][10][11][12][13]15,17,27,39,40 In this series of patients with an average age of more than 70 years, approximately 50% of subjects were alive or free from MACCE at 10 years after surgery; approximately 85% of patients were free from cardiac or cerebrovascular death or from hospital readmission for CHF; approximately 97% of patients were free from PCI or cardiac reoperation; finally, approximately 95% of patients were free from cerebrovascular accident after hospital discharge. Although female sex, extracardiac arteriopathy, chronic dialysis, and poor systolic function before surgery were risk factors for both cardiac or cerebrovascular death and MACCE, active infective endocarditis and prolonged myocardial ischemia during surgery were the sole predictors of repeat operation or PCI.…”