Coronary Artery Bypass Graft Using Both Internal Thoracic Artery Should Be Golden Standard: Is There Any Negative Consideration in Short-Term Outcome?

Objectives: Previous studies showed that the superiority of arterial graft is remarkable in long-term compared with venous grafts. On the other hand, there is still some consideration such as higher postoperative wound infection rate, longer procedural and more technical demanding. After these results from several studies, the bypass graft choice might have been changed. However, is there sufficient information to state arterial grafts are superior or inferior to venous grafts? We aimed to compare the short-term outcome in high volume center between both internal thoracic artery (BITA) and single ITA with saphenous vein graft (SVG) in this current era.

Methods: We performed a retrospective review of patients who underwent isolated surgical multiple revascularization for coronary artery disease at our institution between January 2016 and July 2019. A total of 1352 patients are involved to compare the hospital outcome between BITA (group 1: n = 854) and single ITA + SVG (group 2: n = 498). CABG without ITA use or without second graft, CABG using both ITAs and SVG, and single anastomosis were excluded. In terms of preoperative status, group 2 presented with higher morbidity. For better comparability, propensity matching was performed (n = 297).

Result: After statistical matching, incidences of major adverse cardiac events (MACCE: all cause of death, myocardial infarction, coronary revascularization, major stroke) were similar excepting more acute renal failure in group 2 (p = 0.043). Complete revascularization rate, procedure duration, rethoracotomy due to bleeding and postoperative wound infection rate was also comparable. Significant more red blood cell concentrates were transfused in group 2 (p < 0.001).

Conclusion: Hospital outcome of revascularization using BITA is comparable to single ITA with SVG. Surgical procedure with BIMA is technically more demanding, but this has no negative effect on short-term outcome and possibly a positive impact on long-term results.

Publication History

Article published online:
19 February 2021