Off-pump bilateral internal thoracic artery grafting in right internal thoracic artery to right coronary system

Abstract

BACKGROUND: Despite many large-volume studies on the use of bilateral internal thoracic artery (ITA) grafts, the benefits of a bilateral (B)ITA graft over a single (S)ITA graft for CABG remain controversial. This study compared midterm outcomes of BITA to SITA grafting in off-pump coronary artery bypass (OPCAB), focusing primarily on the right (R)ITA to right coronary artery (RCA) system.

METHODS: From January 2000 to December 2009, 1,749 patients underwent isolated OPCAB with ITA grafts. Using propensity score matching, 366 BITA patients could be pairwise propensity matched to a SITA patient. We compared midterm survival and major adverse cardiac and cerebrovascular event (MACCE) between the 2 groups. All patients in the BITA group underwent bilateral ITA grafting with the RITA anastomosed to the RCA system. Mean follow-up was 84.46±24.47 months (range, 5 to 120 months).

RESULTS: Overall survival at 10 years was not significantly different between the 2 groups (84.6% vs 84.1%; p=0.955). The 10-year cardiac-related death-free rate also did not significantly differ between the groups (90.0% vs 90.9%; p=0.871). The 10-year MACCE-free rate did not significantly differ between the 2 groups (79.7% vs 74.6%; p=0.303).

CONCLUSIONS: At 10-year follow-up, BITA grafting did not offer advantages over SITA grafting in midterm outcomes, at least in the RITA to RCA system. The BITA grafting was similar to SITA grafting in overall and cardiac survival, and MACCE rates.