Should Bilateral Internal Thoracic Artery Grafting be Used After Recent Myocardial Infarction?

Background: Many surgeons are reluctant to use bilateral internal thoracic artery (BITA) grafting in patients after myocardial infarction (MI) due to the increased risk of sternal wound infection(SWI) with BITA and the excellent survival benefit obtained with single internal thoracic artery grafting(SITA). The purpose of this study is to compare early and long-term outcomes of BITA grafting to those of SITA after recent MI.

Methods: Eight hundred seventy one patients who underwent BITA grafting after recent MI(

Results: Those undergoing BITA were younger, more often male, less likely to have chronic obstructive pulmonary disease, ejection fraction <30%, a critical preoperative state, diabetes, emergency operation, chronic renal failure, and peripheral vascular disease; and more likely to have acute MI( 7 days), and three vessels disease . Operative mortality of BITA patients was lower (3.0 % vs. 5.7%, p=0.01). Occurrences of SWI (3% vs 2% ) and stroke (2.6% vs. 3.0%) were similar. Median follow-up was 13.40 (95% CI 12.04-14.72) years. Kaplan Meier ten years survival of BITA patients was better (70.3% vs. 52.6%, p<0.001). Multivariate analysis using propensity score matching showed similar survival rates for the two groups. However, survival of non–emergent BITA patients was better (HR 1.256, p=0.038).

Conclusion: Long-term outcome of arterial revascularization with BITA was better than that of SITA in non-emergency cases after recent MI. SITA was not inferior to BITA in emergency cases following recent MI.