Long term Outcome of Revascularization with Composite T Grafts: is Bilateral Mammary Grafting Better than Single Mammary and Radial Artery?

Objective: Bilateral Internal mammary (BIMA) grafting is associated with improved survival. However, many surgeons are reluctant to use this technique due to the potentially increased risk of sternal infection. The composite T graft with radial artery attached end-to-side to the left internal mammary artery (IMA) provides complete arterial revascularization without increased risk of sternal infection. The purpose of this study is to compare outcome of these two revascularization strategies.

Methods: Patients who underwent BIMA grafting using the composite T graft technique between 1996 and 2010 (n = 1329) were compared with 389 patients who underwent composite grafting with a single IMA (SIMA) + radial artery during the same time period.

Results: Patients undergoing SIMA were older, more often female, and more likely to have diabetes, PVD, COPD, or an emergency operation On the other hand, congestive heart failure Left main disease and recent MI were more prevalent in the BIMA group. Propensity score matching was used to account for differences between groups in preoperative patients` characteristics. The 268 matched pairs created had similar preoperative characteristics

The median follow-up was 14.19 (95% CI 13.43-14.95) years. Operative mortality and Kaplan Meier 10 year survival of the two matched groups were similar(3.4% versus 3.7% and 61.6%, versus 64%, for the BIMA and SIMA groups, respectively,) Cox adjusted survival was also similar. (p=0.514). Age, Chronic renal failure and the performance of fewer than 3 bypass grafts were independent predictors of decreased survival.

Conclusion: This study suggests that long-term outcome of arterial revascularization with composite T graft constructed using left IMA and radial artery is not inferior than that of BIMA.