Abstract 13199: Impact of In-Situ Right Internal Thoracic Artery Grafting via the Transverse Sinus on Long-Term Outcomes After Coronary Artery Bypass Grafting

• Published in: Circulation (New York, N.Y.) Vol. 140; no. Suppl_1 Suppl 1; p. A13199
• Main Author: Hakamada, Keisuke
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 19.11.2019
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.13199

IntroductionThe use of the left internal thoracic artery (LITA) to graft the left anterior descending artery has been widely accepted as the gold standard for coronary artery bypass grafting (CABG). However, little is known about the long-term outcomes of in-situ right internal thoracic artery (RITA) grafting to the left circumflex area via the transverse sinus.MethodsBetween January 2007 and December 2016, a total of 1674 patients underwent isolated CABG in our institution. Bilateral ITA was used in 493 patients (Group B); In-situ LITA was anastomosed to LAD and In-situ RITA was anastomosed to the left circumflex area via the transverse sinus. Single ITA was used in 979 patients (Group S); In-situ LITA was anastomosed to LAD and saphenous vein grafts were anastomosed to the left circumflex area. These groups were compared in terms of long-term survival and major adverse cardiovascular events.ResultsUnadjusted thirty-day mortality was not different between the two groups (0.5% and 0.4% for group B and S, p= 1.00). Propensity score matching was used to compare 493 BITA and SITA patient pairs. (Figure) Kaplan-Meier analysis showed that the cumulative incidence of all-cause death at 10-year was significantly lower in the group B than Group S (14.0% and 16.4% for group B and S, Log rank; p= 0.04). The cumulative incidence of cardiac death had a tendency to be lower in the group B than Group S (4.3% and 6.1%, p=0.07) and the incidence of myocardial infarction (MI) at 10-year was significantly lower in the group B than Group S (0% and 1.2%, p<0.01). On the other hand, the incidence of repeat revascularization was not significantly different between the groups (7.5% and 7.5%, p=0.53)ConclusionsThirty-day mortality after CABG was not different in both groups. In-situ RITA grafting via transverse sinus was associated with lower risks of long-term death and cardiovascular events. The incidence of repeat revascularization after CABG was not different regardless of the use of BITA/SITA.