Abstract 18394: Off-Pump Bilateral versus Single Skeletonized Internal Thoracic Artery Grafting in High Risk Patients
Introduction: We compared the outcomes in propensity score-matched high-risk patients (Euro SCORE ≥ 5) undergoing isolated off-pump CABG using bilateral or single internal thoracic artery (ITA).
Methods: Among 794 consecutive patients undergoing isolated CABG (99.2% by off-pump technique without conversion to cardiopulmonary bypass) between 2002 and 2009, 581 patients had Euro SCORE ≥ 5 and underwent isolated off-pump CABG using skeletonized single (n = 236) or bilateral ITA (n = 300) with complementary saphenous vein and/or gastroepiploic artery. After excluding 45 patients who had only one target vessel at the left coronary area, 235 pairs were matched using propensity scores created based on 7 preoperative factors (C statistics 0.65, 95% CI 0.61 – 0.70).
Results: Bilateral ITA was unexceptionally anastomosed to left coronary system. The rate of deep sternal infection was similar between the groups. Mean observation period was 3.2 years. The 5-year survival free from overall death in bilateral versus single ITA grafting was 85.8% versus 74.8% (log-rank test, p = 0.002). For freedom from cardiac event (cardiac death, myocardial infarction, and repeat revascularization), the respective rate was 87.4% versus 66.1% (p = 0.001). In multivariate Cox models, bilateral ITA grafting was significantly associated with a lower risk for overall death (hazard ratio, 0.51; 95% CI, 0.30 – 0.88; p = 0.014) and cardiac event (hazard ratio, 0.39; 95% CI, 0.22 – 0.70; p = 0.001).
Conclusions: In high risk patients, off-pump skeletonized left-sided bilateral ITA grafting is associated with better outcomes than single ITA grafting without increasing the risk of deep sternal infection.
- © 2010 by American Heart Association, Inc.