Abstract 520: Should Bilateral Internal Thoracic Artery Grafting be Used in Patients with Peripheral Vascular Disease?

Abstract

Background: The potential survival benefit of Bilateral Internal Thoracic Artery (BITA) compared to Single Internal Thoracic Artery (SITA) grafting in peripheral or cerebral vascular disease (PVD) patients is questionable, due to their short life expectancy and increased risk of sternal wound infection. Methods: Six hundreds and four Patients with PVD who underwent BITA grafting between 1996 and 2010 were compared with 478 PVD patients who underwent SITA grafting. Results: Patients undergoing SITA were older, more often female, more likely to have chronic obstructive lung disease, EF<30% ,Diabetes, renal insufficiency, congestive heart failure and emergency operation. Euroscore of SITA patients was significantly higher(10.1 ±3.1vs. 8.1± 3.3 %,p<0.001) Operative mortality (4.4% vs. 5.0% in BITA and SITA)and sternal wound infections (4.4% vs. 3.6%) were not significantly different between groups. Median follow-up was 9.50 (95%CI 8.83-10.16) years. Ten-year survival (Kaplan-Meier ) of the SITA and BITA groups were not significantly different (45.1±4.7% vs. 50.1±3.4%, P =0.736, Log Rank test) and assignment to the BITA group was not associated with better propensity-adjusted survival (HR 1.050, 95% CI: 0.875-1.261, P =0.600) ( Stratified COX model. ) Conclusions: This study shows. that, early and long-term outcomes of BITA grafting in patients with PVD are not better than those of SITA grafting. Early mortality from non-cardiac causes ,reduces the influence of the type of conduit used(BITA or SITA) on survival. Selective use of BITA in lower-risk PVD patients might un-mask the benefits of BITA grafting