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Thorac Cardiovasc Surg
DOI: 10.1055/a-2524-9264
Original Cardiovascular

Time-Varying Association of the Second Internal Thoracic Artery with Long-Term Survival after Coronary Artery Bypass Grafting

Authors

  • Ibrahim Gadelkarim   *

    1   University Department of Cardiac Surgery, Heart Center Leipzig, Sachsen, Leipzig, Germany

  • Mateo Marin-Cuartas    *

    1   University Department of Cardiac Surgery, Heart Center Leipzig, Sachsen, Leipzig, Germany

  • Sergey Leontyev

    1   University Department of Cardiac Surgery, Heart Center Leipzig, Sachsen, Leipzig, Germany

  • Manuela De La Cuesta

    1   University Department of Cardiac Surgery, Heart Center Leipzig, Sachsen, Leipzig, Germany

  • Salil V. Deo

    2   Department of Cardiac surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, United States

  • Martin Misfeld

    3   The Discipline of Medicine, The Central Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia

  • Piroze Davierwala

    4   Department of Surgery, Division of Cardiac surgery, Toronto General Hospital, Toronto, ON, Canada

  • Michael Borger

    1   University Department of Cardiac Surgery, Heart Center Leipzig, Sachsen, Leipzig, Germany

  • Alexander Verevkin

    1   University Department of Cardiac Surgery, Heart Center Leipzig, Sachsen, Leipzig, Germany
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Abstract

Background

The survival advantages of bilateral internal thoracic artery (BITA) grafts in coronary artery bypass grafting (CABG) surgery remain unclear. Therefore, this study aims to systematically evaluate the time-dependent influence of BITA on long-term survival in elective CABG patients presenting with stable multivessel coronary artery disease.

Methods

Data from 3,693 patients undergoing isolated CABG with single internal thoracic artery (SITA) or BITA, with or without additional vein grafts, between 2002 and 2012 were retrospectively analyzed. The entire cohort was divided into BITA and SITA groups (830 vs. 2,863 patients). A 1:3 propensity score matching was performed. Subsequent analysis of a subgroup meeting Randomized comparison of the clinical Outcome of single versus Multiple Arterial grafts (ROMA) trial criteria (n = 1,339) followed a 1:1 matching. Differences in restricted mean survival time (RMST) estimates were used to assess the time-varying association of BITA with long-term survival.

Results

In-hospital mortality (SITA 1.8% vs. BITA 1.1%, p = 0.2) and major postoperative complications were similar between the matched groups. However, long-term survival was significantly higher in BITA patients for the matched whole cohort (15-year survival: 64 vs. 51%, respectively; p < 0.001) and the ROMA-like population (76 vs. 60%, respectively; p < 0.001). RMST demonstrated an incremental survival advantage of BITA over SITA grafting over time for both the whole and ROMA-like populations (0.1, 0.5, and 1.1 years, and 0.1, 0.4, and 1.0 years at 5-, 10-, and 15-year follow-up, respectively)

Conclusion

BITA grafting is safe and associated with superior long-term survival compared with SITA and vein grafts, with benefits extending beyond 5 years for the entire cohort and beyond 10 years for ROMA criteria patients.

Keywords

bilateral internal thoracic arteries - coronary artery bypass surgery - survival

Authors' Contribution

We would like to highlight that this manuscript features shared first and last authorships. I.G. and M.M.C. have contributed equally to this work, playing significant roles in conceptualization, data collection, critical analysis, and manuscript preparation. Similarly, A.V. and M.B. have jointly supervised the project, ensuring rigorous scientific oversight, and contributing equally to the conceptualization, data interpretation, and manuscript preparation.


* These authors contributed equally to this work.


Supplementary Material



Publication History

Received: 05 September 2024

Accepted: 23 January 2025

Accepted Manuscript online:
27 January 2025

Article published online:
13 March 2025

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