Bilateral Internal Thoracic Artery Grafts in Hemodialysis: A Single-Center Propensity Score Analysis

Abstract

Clinical evidence comparing the surgical risk and long-term effectiveness of the bilateral internal thoracic artery (BITA) and single internal thoracic artery (SITA) for coronary artery bypass grafting (CABG) in hemodialysis patients is limited. We sought to clarify the short-term and midterm outcomes of CABG using BITA or SITA grafts in hemodialysis patients. Between October 2000 and December 2015, 161 hemodialysis patients underwent isolated CABG by internal thoracic artery grafting; 67 received BITA grafts and 94 SITA grafts. Propensity score matching was used to compare 59 BITA and SITA patient pairs. BITA and SITA grafts resulted in comparable 30-day mortality (1.7% vs 0%, p= 1.00), incidence of deep sternal wound infection (5.1% vs 1.7%, p= 0.62), stroke (3.4% vs 3.4%, p= 1.00), and respiratory failure (8.5% vs 11.9%, p= 0.75). The Kaplan-Meier model showed the survival rate in the BITA and SITA groups was 83.4% ± 5.1% vs 87.0% ± 4.6% at 1 year, 69.1% ± 7.3% vs 68.5% ± 6.9% at 3 years, and 47.4% ± 10.45% vs 58.2% ±8.1% at 5 years of follow-up, respectively. There were no statistical differences in survival (p= 0.81), freedom from cardiac death (p= 0.51), or freedom from cardiac events (p= 0.85). CABG using BITA grafts showed no advantages in midterm outcome among hemodialysis patients; however, there were no adverse effects on perioperative morbidity or death. For hemodialysis patients with limited available conduits, BITA may be an important option for multivessel revascularization.