Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.
Ann Thorac Surg. 2012 Sep;94(3):717-24. doi: 10.1016/j.athoracsur.2012.04.066. Epub 2012 Jul 15.
Despite many large-volume studies on the use of bilateral internal thoracic artery (ITA) grafts, the benefits of a bilateral (B)ITA graft over a single (S)ITA graft for CABG remain controversial. This study compared midterm outcomes of BITA to SITA grafting in off-pump coronary artery bypass (OPCAB), focusing primarily on the right (R)ITA to right coronary artery (RCA) system.
From January 2000 to December 2009, 1,749 patients underwent isolated OPCAB with ITA grafts. Using propensity score matching, 366 BITA patients could be pairwise propensity matched to a SITA patient. We compared midterm survival and major adverse cardiac and cerebrovascular event (MACCE) between the 2 groups. All patients in the BITA group underwent bilateral ITA grafting with the RITA anastomosed to the RCA system. Mean follow-up was 84.46±24.47 months (range, 5 to 120 months).
Overall survival at 10 years was not significantly different between the 2 groups (84.6% vs 84.1%; p=0.955). The 10-year cardiac-related death-free rate also did not significantly differ between the groups (90.0% vs 90.9%; p=0.871). The 10-year MACCE-free rate did not significantly differ between the 2 groups (79.7% vs 74.6%; p=0.303).
At 10-year follow-up, BITA grafting did not offer advantages over SITA grafting in midterm outcomes, at least in the RITA to RCA system. The BITA grafting was similar to SITA grafting in overall and cardiac survival, and MACCE rates.
尽管有许多关于双侧内乳动脉（ITA）移植的大宗研究，但在非体外循环冠状动脉旁路移植术（OPCAB）中，双侧 ITA 移植（BITA）相对于单支 ITA 移植（SITA）的优势仍存在争议。本研究主要关注右乳内动脉（RITA）与右冠状动脉（RCA）系统，比较了 BITA 与 SITA 搭桥在中期的结果。
从 2000 年 1 月至 2009 年 12 月，1749 例患者接受了单纯 OPCAB 和 ITA 移植。通过倾向评分匹配，366 例 BITA 患者可以与 1 例 SITA 患者配对。我们比较了两组患者的中期生存率和主要不良心脏和脑血管事件（MACCE）。所有 BITA 组患者均行双侧 ITA 移植，RITA 吻合至 RCA 系统。平均随访时间为 84.46±24.47 个月（5 至 120 个月）。
两组患者 10 年总生存率无显著差异（84.6% vs 84.1%；p=0.955）。两组患者 10 年心脏相关死亡率也无显著差异（90.0% vs 90.9%；p=0.871）。两组患者 10 年 MACCE 发生率也无显著差异（79.7% vs 74.6%；p=0.303）。
在 10 年随访中，至少在 RITA 至 RCA 系统中，BITA 移植并未在中期结果上优于 SITA 移植。BITA 移植在总生存率和心脏生存率以及 MACCE 发生率方面与 SITA 移植相似。
