OBJECTIVES
Peripheral Vascular Disease (PVD) is known to be a significant risk factor for early as well as long term mortality after Coronary Artery Bypass Grafting (CABG) .
Potential survival benefit of using Bilateral Internal Thoracic Artery (BITA) grafting in this subset of patients is questionable due to their short life expectancy and the increased risk of sternal infection compare to operations incorporating Single Internal Thoracic Artery (SITA). The purpose of this study is to compare early and long term outcome of patients undergoing BITA grafting to that of patients undergoing CABG with SITA and other conduits such as saphenous vein graft (SVG) or radial artery (RA) in patients with PVD.
METHODS:
Four hundred seventy one patients with PVD who underwent BITA grafting between 1996 and 2003 were compared with 268 patients who underwent CABG with SITA
RESULTS
Occurrence of female gender was higher in the SITA group (31.7%vs. 22.9%, P= 0.000, BITA vs. SITA , respectively) as well as diabetes (48.9%vs. 38.2. %, P=0.003) emergency operation (22%vs.15.1% , p= 0.012), chronic obstructive pulmonary disease (24.3%vs. 11%, p=0.000) and chronic renal failure (19.5%vs. 10.6%, p= 0.001). On the other hand congestive heart failure (33.1% vs19.4.%, P= 0.000), and recent myocardial infarction (29.9% vs. 18.7%, P= 0.000) were more prevalent among BITA patients.
Euroscore of SITA patients was significantly higher (9.45 +3.1 vs. 7.68 + 3.6 P= 0.000).
Operative mortality (7% vs. 8.6%, BITA vs. SITA), post operative stroke (5.3% vs. 4.1%) and sternal wound infections (3.2% vs. 3.4%) were not significantly different between groups
.
Mean follow–up was 8.85+ 4.95 years. Ten year survival (Kaplan-Meier) of the SITA group was not significantly lower. (47.4% vs. 54.5%, log rank test),
Assignment to the SITA group was also associated with similar adjusted survival (p < 0.001, compared to the BITA group, COX model)
CONCLUSIONS: This large cohort study shows that, with selective use of BITA and SITA, long term outcome of SITA patients with PVD is not inferior than that of BITA patients.
