Objective: Contemporary data regarding long-term outcomes following coronary artery bypass grafting in patients with severe left ventricular (LV) systolic dysfunction are scarce. We aimed to determine survival-outcomes in subsets of patients undergoing bilateral internal thoracic artery (BITA) grafting.
Methods: The data of 181 consecutive patients with severe LV dysfunction (defined as ejection fraction of 30% or less) undergoing BITA grafting between 2006 and 2014 were analyzed. Patients were categorized according to the left or right target-coronary system revascularization and subgrouped by the type of BITA configuration.
Results: Mean age was 58.2±5 years and male gender comprised 94% of all patients. Grafts/patient ratio was 3.98±1 (2.95±0.8 ITA grafts per patient). Complementary radial artery conduits were used in 57% and arterial revascularization was complete in 88.5% (BITA only, 26%). BITA arrangements were left-sided or classical in 85% and 15% of patients, respectively. Left-sided BITA configurations were retroaortic right ITA (RITA), T-grafts and anteaortic RITA in 42%, 45% and 13% of the patients.
Early mortality was 2.2%. Late all-cause mortality during 8-year follow-up was 8.2% (left-sided vs classical BITA, p=0.55). Correspondingly, the 1-year, 5-year and 8-year overall survival rate was 98%, 93% and 92%, respectively (Kaplan-Meier). Survival plateau was evident beyond 5 years. There was no survival difference between T-graft or in-situ BITA techniques (p=0.58).
Conclusion: BITA grafting confers good long-term survival in patients with severe LV dysfunction irrespective of BITA configuration or targets. This technique should be, therefore, favorably considered when selecting the revascularization approach in these subsets.
