Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience

• Published in: The Thoracic and cardiovascular surgeon Vol. 65; no. 4; p. 265
• Main Authors: Perrotti, Andrea, Spina, Amedeo, Dorigo, Enrica, Durst, Camille, Kaili, Djamel, Chocron, Sidney
• Format: Journal Article
• Language: English
• Published: Germany 01.06.2017
• Subjects: Aged; Aged, 80 and over; Cardiopulmonary Bypass; Chi-Square Distribution; Coronary Artery Bypass, Off-Pump - adverse effects; Coronary Artery Bypass, Off-Pump - methods; Coronary Artery Bypass, Off-Pump - mortality; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Databases, Factual; Feasibility Studies; Female; France; Humans; Internal Mammary-Coronary Artery Anastomosis - adverse effects; Internal Mammary-Coronary Artery Anastomosis - methods; Internal Mammary-Coronary Artery Anastomosis - mortality; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Postoperative Complications - etiology; Postoperative Complications - mortality; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 1439-1902
• DOI: 10.1055/s-0036-1584688

Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses.  The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a  < 0.3 at univariate analysis.  Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3-9.9 and OR: 5.4, 95% CI: 1.3-21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (  = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%,  = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2-33.5), that was unfailingly due to ungraftable right coronary artery targets.  BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.