Double thoracic artery--halved mid-term mortality? A 5-year follow-up of 716 patients receiving bilateral ITA versus 662 patients with single ITA.

UNLABELLED

The superior patency of ITA grafts to saphenous veins is conclusive. The aim of the study was to collate mid-term benefit between patients receiving bilateral ITA (BITA) or single ITA (SITA). Outcome of 1378 pts with isolated CABG operated between 1/97-8/99 was analyzed retrospectively. Follow-up was 4.0 to 6.6 years (average 5.3). A total of 716 pts received BITA, 662 SITA and additional saphenous veins. We evaluated mortality rate, freedom from reoperation, intervention (PTCA/stent), and incidence of cardiac events and quality of life with respect to pts risk factors. Demographic data: Male gender was more frequent in both groups (BITA females: n=115; males: n=601; SITA females: n=150; males: n=512; p<0.01). Mean age was comparable in both groups with 69.2 years (42.7 to 88.6 years) in the BITA group and 71.0 years (47.3 to 91.6 years) (n. s.) in the SITA group.

RISK FACTORS

Incidence of diabetes mellitus (26.0 vs 25.9%) as well as the mean BMI (27.4 vs 27.0%) did not differ statistically in both groups.

RESULTS

Clinical characteristics like NYHA/ CCS classifications showed a significant difference towards superior results only for stadium I in the BITA group. Mortality/cardiac events after 5.3 years average: Total mortality revealed 5.2% (n=37) in the BITA vs 9.1% (n=60) in the SITA group (p</=0.005). The cardiac-related mortality was 0.7% (n=5) in the BITA and 2.0% (n=13) in the SITA group (p<0.05). The non-cardiac-related mortality did not differ significantly (2.7 vs 2.9%). The incidence of redo-operations was 0.1% (BITA) vs 0.6% (SITA) (n. s). Cardiac interventions like PTCA or stent were performed in 3.1% (BITA) vs 4.7% (SITA) or 3.7% (BITA) vs 4.2% (SITA) (n. s.) respectively. Infarction-rate was 2.0% in the BITA and 3.0% in the SITA group (n. s.).

CONCLUSIONS

Mid- to long-term benefit of patients receiving bilateral ITA is superior to those with single ITA. Cardiac-related mortality and incidence of reoperation was reduced to less than half after BITA grafting. Freedom from cardiac interventions (PTCA/stent), NYHA/CCS classifications and quality of life were rarely influenced by BITA frequency.