Abstract 3245: Routine Use of Bilateral Skeletonized Internal Thoracic Artery Grafting -Early and Long Term Results
Background: Skeletonized harvesting of the internal thoracic artery (ITA) decreases severity of sternal devascularization, thus reducing the risk of postoperative sternal complications in patients undergoing bilateral ITA grafting (BITA).
Methods: From May 1996 to December 2001, 1518 consecutive patients underwent skeletonized BITA grafting. Of the 1175 male and 343 female patients, 659 (43.4%) were older than 70 years and 578 (38.1%) had diabetes.
Results: Operative mortality was 2.9%. Early postoperative morbidity included sternal infection (1.5%), cerebrovascular accident (2.7%) and perioperative myocardial infarction (0.9%). Multiple regression analysis showed chronic obstructive pulmonary disease (COPD) (OR 8.6, 95% CI 3.5–20.9), repeat operation (OR 6.7; 95% CI 1.7–26.4) and chronic renal failure (OR 3.1, 95% CI, 1.1– 8.9) to be associated with increased risk of sternal infection. Follow-up (60 –127 months) revealed 274 late deaths. Kaplan-Meier 10 year survival for patients younger than 65, between 65–74, and older than 75 was 84%, 77% and 66%, respectively. Cox regression analysis revealed increased overall mortality (early and late) in patients with peripheral vascular disease (RR 2.4, 95% CI 1.8 –3.2), patients older than 75 years (RR 2.1, 95% CI, 1.4 –3.3), repeat operations (RR 2.0, 95% CI 1.1–3.6), patients with preoperative acute myocardial infarction (RR 1.6; 95% CI 1.2–2.0, and in diabetics (RR 1.5, 95% CI 1.2–1.9). Postoperative coronary angiography performed in 252 symptomatic or ischemic patients revealed an ITA patency rate of 90.8%.
Conclusions: BITA grafting is associated with low morbidity and good long term results. Use of skeletonized BITA is an appropriate technique for the elderly and diabetics; however, it is not recommended for repeat operations or for patients with COPD.