Long-Term Results of Bilateral Internal Thoracic Artery Grafting in Dialysis Patients

• Published in: The Annals of thoracic surgery Vol. 83; no. 5; pp. 1666 - 1671
• Main Authors: Kai, Masashi, MD, Okabayashi, Hitoshi, MD, PhD, Hanyu, Michiya, MD, PhD, Soga, Yoshiharu, MD, PhD, Nomoto, Takuya, MD, PhD, Nakano, Jota, MD, Matsuo, Takehiko, MD, Umehara, Eitaro, MD, Kawato, Masahide, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2007; Elsevier Science
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiothoracic Surgery; Coronary Stenosis - complications; Coronary Stenosis - surgery; Emergency and intensive care: renal failure. Dialysis management; Female; Humans; Intensive care medicine; Internal Mammary-Coronary Artery Anastomosis - methods; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; Renal Dialysis; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgery of the respiratory system; Treatment Outcome; 23; Human; Prognosis; Respiratory disease; Hemodialysis; Bilateral; Thorax; Long term; Extrarenal dialysis; Treatment; Aortocoronary; Bypass; Surgery; Internal mammary artery
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2006.12.010

Background We evaluated the perioperative and long-term results of bilateral internal thoracic artery grafting in dialysis patients. Methods One hundred one consecutive patients on chronic dialysis who underwent isolated coronary artery bypass grafting were retrospectively compared according to the surgical technique, bilateral internal thoracic artery (BITA) grafting (n = 76) or single internal thoracic artery (SITA) grafting (n = 25). Results Hospital mortality was 5.3% in the BITA group and 8.0% in the SITA group ( p = not significant). The incidence of mediastinitis was not different (7.9% in the BITA group and 8.0% in the SITA group). The median duration of follow-up was 3.1 years (range, 0.1 to 10.9). Survival and freedom from cardiac mortality were not different between the two groups, but the BITA group had a trend toward better results. Freedom from cardiac events (including cardiac-related death, myocardial infarction, pecutaneous coronary intervention, redo coronary artery bypass grafting, and congestive heart failure) was superior in the BITA group ( p = 0.03). Calcification of the ascending aorta, peripheral vascular disease, insulin-dependent diabetes mellitis, and age were the independent risk factors of late death. Conclusions Perioperative results of BITA grafting in dialysis patients were not different from the results of SITA grafting. However, the long-term results of BITA grafting in dialysis patients were better than the results of SITA grafting. Overall, our results support the continued use of BITA grafting in dialysis patients.