Bilateral Internal Thoracic Artery Grafting Is Associated With Significantly Improved Long-Term Survival, Even Among Diabetic Patients

Ann Thorac Surg. 2012 Sep;94(3):710-5; discussion 715-6. doi: 10.1016/j.athoracsur.2012.03.082. Epub 2012 Jun 6.

Abstract

Background: This study examines if bilateral internal thoracic artery (BITA) grafting provides improved outcomes compared with single internal thoracic artery (SITA) grafting, in the modern era, in which diabetes mellitus and obesity are more prevalent.

Methods: The Society of Thoracic Surgeons database at a single large academic center was reviewed for all consecutive isolated coronary artery bypass grafting patients with two or more distal anastomoses from January 1, 2002, through December 31, 2010. Propensity-adjusted logistic and Cox regression models were used to estimate the effect of BITA on short-term outcomes and long-term survival for diabetic and nondiabetic patients.

Results: A total of 3,527 coronary artery bypass grafting operations (812 BITA, 2,715 SITA) were performed. Fewer BITA than SITA patients had diabetes (28.6% vs 44.7% p<0.001). There was no significant difference in 30-day rates of death, stroke, or myocardial infarction between nondiabetic patients who had BITA vs SITA, or between diabetic patients who had BITA vs SITA. BITA grafting conferred a 35% reduction (95% confidence interval, 12% to 52%, p=0.006) in the long-term hazard of death equally for nondiabetic and diabetic patients (p=0.93). Deep sternal wound infection was more common among diabetic than among nondiabetic patients (1.5% vs 0.7%), but was similar within nondiabetic (1.0% vs 0.6%) and diabetic patients (1.7% vs 1.5%) who had BITA vs SITA. Overall, BITA and SITA patients had similar rates of deep sternal wound infection (1.2% vs 1.0%).

Conclusions: BITA grafting confers a long-term survival advantage and should be performed whenever suitable coronary anatomy exists and patient risk factors allow an acceptable risk of deep sternal wound infection.

Publication types

  • Comparative Study

MeSH terms

  • Academic Medical Centers
  • Aged
  • Cohort Studies
  • Coronary Artery Bypass / methods*
  • Coronary Artery Bypass / mortality*
  • Coronary Disease / mortality
  • Coronary Disease / surgery
  • Databases, Factual
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / mortality*
  • Diabetes Mellitus / surgery*
  • Female
  • Follow-Up Studies
  • Graft Rejection
  • Graft Survival
  • Humans
  • Internal Mammary-Coronary Artery Anastomosis / methods
  • Internal Mammary-Coronary Artery Anastomosis / mortality
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Mammary Arteries / surgery
  • Mammary Arteries / transplantation*
  • Middle Aged
  • Odds Ratio
  • Postoperative Complications / mortality
  • Postoperative Complications / physiopathology
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Survival Analysis
  • Time Factors
  • Treatment Outcome