Sequential vs Individual anastomosis in BITA coronary bypass grafting

Objective
The documented advantage BITA grafting utilization along with the beneficial effect of
complete coronary revascularization during CABG , provides a strong rationale for targeting
as many coronary arteries as possible with ITA grafts. While Sequential ITA anastomoses is
considered to be more technically demanding, it enables revascularization of additional
coronary vessels with these ITA grafts. We sought to evaluate whether performing
sequential grafting utilizing bilateral IMA`s offers any early or late clinical benefit compared
to BITA utilization without the employment of sequential techniques.
Methods
This is a single-center retrospective study. We reviewed all patients who
underwent isolated coronary artery bypass grafting (CABG) between 1996
and 2011 at our center. The cohort was divided into two groupsboth utizing bilateral ITA
during CABG, one with sequential technique (BITA-S), and one without any sequential
anastomosis (BITA-NS).
Results
During the study period, 5,301 patients underwent CABG surgery. Among them,
2,839 patients received BITA revascularization. Of these, 1,235 patients underwent
BITA grafting with a sequential anastomosis technique (BITA-S group), while 1,604
patients had BITA revascularization without sequential grafting (BITA-NS group).
As anticipated, patients in the BITA-S group were more likely to receive more than
three bypass grafts, even after matching. Early outcomes, (including wound
infection, stroke, revision, perioperative MI and early mortality), were comparable
between the two groups in both matched and unmatched cohorts, as well as after
multivariable analysis adjusted for Euroscore. In contrast, late mortality was
significantly lower in the BITA-S group within the matched cohort (p<0.001). The
matched cohort multivariable analysis further identified the sequential anastomosis
technique as a significant factor associated with improved long-term outcomes (HR
0.71 (0.577-0.873), P=0.001.
Conclusions
Our study demonstrated a long-term survival advantage for patients undergoing
BITA revascularization utilizing sequential grafting technique compared to those
receiving BITA revascularization with discrete anastomoses alone.