BILATERAL INTERNAL THORACIC ARTERY GRAFTING: FIFTEEN YEARS OF EXPERIENCE

Highlights Bilateral internal thoracic artery (BITA) grafting is one of the most effective methods of direct myocardial revascularization. However, its results are still contradictory, despite the worldwide trend to use more autogenous arterial conduits. This study involves more than fifteen years of data in the use of BITA in Kuzbass in coronary artery disease surgery. The findings presented in the course of the analysis confirm the need to use both internal mammary arteries more actively. Aim. To analyze long-term results of BITA grafting in terms of more than 15 years follow-up. Methods. The study included 232 patients who were admitted at the Cardiac Surgery Department for coronary artery bypass grafting (CABG). All patients were divided into 2 groups depending on usage of single or bilateral internal thoracic artery conduits. Both groups included an equal number of patients 116 (50%). Long-term results were assessed in terms of more than 15 years follow-up. Results. BITA grafting is comparable with CABG in such major adverse cardiac and cerebrovascular events as repeated myocardial revascularization, stroke, and in combined endpoint such as myocardial infarction (MI), stroke, repeated myocardial revascularization, or patient’s death within 15 years. However, the BITA group is superior to the CABG group in freedom from MI, all-cause deaths, showing a higher life expectancy after surgery (p = 0.011), and improved left ventricular ejection fraction and decreased functional class of angina. Moreover, in the present research it was confirmed that the severity of atherosclerosis in the coronary arteries is lower after bypassing with autogenous arterial conduits. Conclusion. BITA is safe procedure comparable with CABG, however, it has more advantageous long-term clinical and angiographic results.