Does Bilaternal vs Single Toracic Artery Grafting Provide Survival Benefit in Female Patients?

Objective: Bilateral internal thoracic artery grafting (BITA) is associated with improved survival but the using this technique are reluctant in female patients due to increased risk of sternal wound infection (SWI). The aim of this study to compare late survival of women underwent BITA or single thoracic artery (SITA) grafting.

Methods: We performed a retrospective analysis of 556 consecutive female BITA patients compared to 685 female SITA patients.

Results: SITA patients were older and more likely to have comorbidities (diabetes mellitus, chronic lung disease, chronic renal failure, peripheral vascular disease, cerebral vascular disease). Operative mortality showed a trend towards a benefit for BITA (2.9% versus 5.0% for SITA, P=0.06). SWI rates were similar (3.4% vs 2.9%, respectively, P=0.6), however, occurrence of stroke was significantly lower in the SITA group (3.4% vs 1.2%, P=0.007). Median survival of the BITA group was significantly better (13.8 years [95% CI, 12.8-14.9] vs 10.3 years [95%CI, 9.6-11.1], P=0.001). After propensity score matching (491 pairs), assignment to BITA was not associated with increased early mortality or complication rates, and choice of BITA grafting was associated with better survival (14.5 years [95% CI, 13.3-15.6] vs 11.8 years [95%CI, 10.7-12.9]). Only the choice of conduits was associated with increased late mortality (multivariate analysis, HR 1.28 [95% CI, 1.024-1.591], P=0.03).

Conclusion: Our study results support the use BITA grafting in women. The low early mortality and complication rate and long term survival benefit compare to SITA grafting provides additional evidence in effort to improve long term results in CABG patients.