Abstract 40: Should Bilateral Internal Thoracic Artery Grafting Be Used in Emergency Patients?
HYPOTHESIS: Bilateral Internal Thoracic Artery (BITA) grafting is not often used in emergency coronary artery bypass grafting (CABG) due to questionable survival benefit ,relative complexity and increased risk of sternal infection compared to operations incorporating Single Internal Thoracic Artery (SITA).
The purpose of this study is to compare early and long term outcome of emergent patients undergoing BITA grafting, to that of emergent patients undergoing CABG with SITA
METHODS: Four hundred thirty eight emergency patients underwent BITA grafting between 1996 and 2008. They were compared with 339 emergency patients who underwent CABG with SITA
RESULTS: Occurrence of female gender (18.5% vs. 29.5%, P< 0.001, in the BITA and SITA groups, respectively), diabetes (25.3% vs. 38.6%, P< 0.001), age 70+ (61.0% vs.39.7%, P< 0.001), chronic obstructive pulmonary disease (5.7% vs.13.9%, P< 0.001) EF <30% (12.1% vs. 17.1%, P< 0.001), and chronic renal failure (7.1% vs. 17.1%, p< 0.001) was lower in the BITA group. On the other hand critical preoperative state (35.4% vs. 26.0%, P= 0.003), and recent myocardial infarction (39.5% vs. 32.7%, P= 0.031) were more prevalent among BITA patients. Euro score I of SITA patients was significantly higher (10.58 ± 4.1 vs.8.65 ± 3.5, P= 0.016).
Operative mortality (5.3% vs 7.4%, BITA vs. SITA), and sternal wound infections (2.7% vs. 2.1%) were not significantly different between groups.
Mean follow-up was 8.75 ± 4.75 years. Ten year survival (Kaplan-Meier) of SITA patients with euro score 11+ was similar to that of BITA patients with euro score 11+. (34% vs. 37%, log rank test) .However, Kaplan-Meier 10 year survival of BITA patients with euro score I of 10 or lower was significantly better(80% vs. 68%, , BITA and SITA groups, respectively , P= 0.012 ).Assignment to the BITA group in the subset with lower euro score was also associated with better propensity adjusted survival ( HR 4.8 p < 0.001, compared to the SITA group, COX model)
CONCLUSIONS: This large cohort study shows that,BITA grafting may be used in emergency patients., In medium and low risk emergency patients long term outcome is better than that of patients treated with SITA
Author Disclosures: Y. Ben-Gal: None. R. Mohr: None. D. Pevni: None. A. Ganiel: None. A. Kramer: None. N. Nesher: None. A. Nevo: None. Y. Paz: None. B. Medalion: None.
- © 2014 by American Heart Association, Inc.