Abstract 331: Are Two Internal Thoracic Grafts Better Than One in Patients With Peripheral Vascular Disease?: Analysis of 858 Cases Between 1996- 2011

Abstract

Objectives: Bilateral internal thoracic artery( ITA) grafting is associated with improved survival. However, potential survival benefit of using two ITA`s in patients with peripheral vascular disease(PVD) is questionable due to their short life expectancy and the increased risk of sternal wound infection(SWI) compare to operations incorporating single ITA (SITA). The purpose of this study is to compare early and long-term outcome of bilateral ITA grafting(BITA) to that of SITA and vein grafts in PVD patients with multi-vessels coronary disease. Methods: Five hundred and thirty three PVD patients who underwent BITA between 1996 and 2011 were compared with 319 who underwent SITA . Results: SITA patients were more often female, more likely to have Diabetes, chronic obstructive lung disease, unstable angina, previous CABG, renal insufficiency, Cerebro- vascular disease and emergency operation .On the other hand congestive heart failure and triple vessel coronary disease were more prevalent among BITA patients. Operative mortality(3.5% vs. 4.1%, in the SITA and BITA respectively) and occurrences of SWI (6.6% vs 3.9%) and strokes(4.1% vs 6.8%) were not significantly different between groups . BITA patients did not have better Kaplan- Meier 10 year survival ( 52.1% vs.47.1%, p=0.145) and after propensity score matching(243 well matched pairs) BITA was not associated with better adjusted survival ( HR 1.108[95%CI 0.810-1.516] p=0.521)(cox model) Conclusion: This study does not support routine use of BITA in PVD patients .Earlier mortality from non-cardiac causes, reduces contribution of BITA and increases the influence of PVD and other co-morbidities on survival. Selective use of BITA in lower risk patients might un-mask the benefits of BITA