Thorac Cardiovasc Surg 2017; 65(04): 256-264
DOI: 10.1055/s-0036-1584082
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Urgent Coronary Revascularization with Bilateral Internal Thoracic Artery Grafting: Is the Risk Justified?

Giuseppe Gatti
1  Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy
,
Luca Maschietto
1  Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy
,
Bernardo Benussi
1  Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy
,
Lorella Dreas
1  Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy
,
Gabriella Forti
1  Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy
,
Gianfranco Sinagra
1  Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy
,
Aniello Pappalardo
1  Department of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy
› Author Affiliations
Further Information

Publication History

08 March 2016

23 March 2016

Publication Date:
13 May 2016 (online)

Abstract

Background The frequent need of immediate institution of cardiopulmonary bypass because of ischemia and increased risk of bleeding and longer duration of surgery limit the use of bilateral internal thoracic artery (BITA) grafting in urgency.

Patients and Methods Of 4,525 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery at the authors' institution (1999–September 2015), 121 (2.7%) patients had an operation before the beginning of the next working day after decision to operate, which is the definition for emergency according to the European System for Cardiac Operative Risk Evaluation II. BITA and single internal thoracic artery (SITA) grafting were used in 52 and 46 of these patients, respectively; venous grafts alone were used in the remaining cases. BITA and SITA patients were compared as risk profiles, operative data, and outcomes. A propensity score (PS)-matched analysis was also performed.

Results Between BITA and SITA patients, there was no significant difference as hospital mortality, both in the overall (3.8 vs. 6.5%; p = 0.66) and the PS-matched series (0 vs. 4.3%; p = 1). Among the postoperative complications, only bleeding (but not blood transfusion nor mediastinal re-exploration) was increased both in the overall (p = 0.037) and the PS-matched series of BITA patients (p = 0.092); duration of surgery was increased but not quite significantly (p = 0.12). Freedom from cardiac and cerebrovascular deaths, and major adverse cardiac and cerebrovascular events were higher in PS-matched BITA patients, even though not quite significantly (p = 0.11 for both).

Conclusion BITA grafting may be performed even in urgency. With respect to SITA grafting, hospital mortality and postoperative complications other than bleeding are not increased; late outcomes seem to be better.