Efficacy of Bilateral Internal Thoracic Artery Grafting in Patients With Chronic Kidney Disease

Abstract

This study compared short-term and long-term outcomes in propensity score-matched patients with chronic kidney disease receiving bilateral internal thoracic artery (ITA) or single ITA grafting and assessed any benefit of bilateral ITA grafting for survival. Among 656 consecutive patients undergoing isolated coronary artery bypass grafting (99.1% by off-pump technique) between 2002 and 2008, 361 had chronic kidney disease with no history of dialysis. After excluding 10 patients who would not be potential candidates for bilateral ITA grafting because they were aged older than 85 years and 15 who had only one target vessel at the left coronary area, we identified 157 propensity score-matched pairs. Propensity scores were created based on 13 preoperative factors (C statistics, 0.787). During a mean observation of 2.9 years, the rates of overall death and cardiac death (myocardial infarction, heart failure, and sudden death) in the bilateral ITA group were significantly lower than those in the single ITA group (5.1% vs 15.9%, p=0.01; 1.3% vs 8.3%, p=0.01). In multivariate Cox models including bilateral ITA grafting and all other potential predictors, bilateral ITA grafting was significantly associated with a lower risk for overall death (hazard ratio, 0.29; 95% confidence interval, 0.10 to 0.89; p=0.03) and cardiac death (hazard ratio, 0.14; 95% confidence interval, 0.03 to 0.63; p=0.02). Among patients with chronic kidney disease, bilateral ITA grafting provides better long-term survival than single ITA grafting.