Off-pump bilateral skeletonized internal thoracic artery grafting in patients with chronic kidney disease

Abstract

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.

Impact of Chronic Kidney Disease on Long-Term Outcome of Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus

“…33 Their recent study using propensity-matched analysis showed favorable results for BITA grafting in patients with a markedly impaired renal function (eGFR <30 ml/min/ m 2 ). 34 In the present subgroup analysis, BITA grafting had good efficacy even in DM patients with eGFR <30 ml/min/m 2 . Therefore, the present study suggests that BITA grafting has potential benefits even for DM patients with impaired kidney function.…”

Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta‐Analysis

“…A total of 38 observational studies were selected for the quantitative analysis. Eight nonadjusted, 9 covariate‐adjusted, and 21 PSM studies were included (see Table ) . Twenty‐eight studies (162 989 patients) were performed in the general population, whereas 10 (11 216 patients) were performed in specific subgroups of patients (diabetics: 3 studies [1533 patients]; elderly: 4 studies [6033 patients]; renal failure patients: 1 study [1203 patients]; urgent/emergent cases: 1 study [652 patients]; and patients with low ejection fraction: 1 study [1795 patients]).…”

“…The overwhelming majority of these have shown better outcomes in the BITA treatment group. Several reports have also suggested that the advantages of BITA grafting could be extended to females, diabetics, and patients with chronic renal insufficiency . Over time, this evidence has been summarized in 6 meta‐analyses .…”

“…Several reports have also suggested that the advantages of BITA grafting could be extended to females, 65 diabetics, 66 and patients with chronic renal insufficiency. 48 Over time, this evidence has been summarized in 6 metaanalyses. [4][5][6][7][8][9] All of them showed a significant and similar survival advantage, as measured by the HR, for the use of BITA (see Table 3).…”

Efficacy of Off-Pump Coronary Artery Bypass Grafting Using Skeletonized Bilateral Internal Thoracic Arteries in Diabetic Patients

“…Additionally, one study reported significantly lower re-intervention in the BITA cohort (2.8% vs 10.1%) and better cardiac event-free survival with the use of BITA 13) . However, the efficacy of bilateral ITA use in diabetic patients was not clarified in these studies.…”