Is There a Protective Effect of Sequential Grafting in Coronary Bypass Surgery Using Bilateral Internal Thoracic Artery?

Abstract

Objectives: It is unclear whether the additional bypass techniques to supplement bilateral internal artery grafting (BITA) influence the patient outcome in coronary surgery. We analyzed the impact of sequential ITA grafts on late survival after BITA used on the left side. Methods: From 1989 to 2014, 1644 patients underwent BITA surgery without any additional arterial graft. The revascularization of the left side was optimized with a sequential ITA graft in 824 patients. The revascularization of the right side was performed with an associated vein graft in 599 patients. Propensity score was calculated by logistic regression model and patients were matched 1 to 1 leading to two groups of 334 matched patients. The primary end point was overall mortality from any cause. Results: The population was not homogenous: Greater the arterial revascularization, lower the risk profile. The 30-day mortality was 1.2% without influence of the surgical technique performed. The mean postoperative follow-up was 12.4 ± 6.7 years and 95% complete. Late mortality was significantly influenced by age, heart failure, 3-vessel disease, LV ejection fraction, number of arterial anastomoses and sequential ITA. The significant difference in patients’ survival observed at 20-years in favour of sequential ITA in unmatched groups was confirmed in matched groups. In multivariable Cox model analysis, the use of sequential ITA remained predictor of long-term survival in matched groups. Conclusions: These results confirm that higher the number of ITA anastomoses, better the long-term survival. It is a strong support of the extensive use of arterial grafting with multiple ITA bypass.