Bilateral internal thoracic artery coronary grafting: risks and benefits in elderly patients

Abstract

Aims Whether bilateral internal thoracic artery (BITA) grafting benefits elderly patients in coronary artery bypass grafting (CABG) remains unclear since they tend to have a limited life expectancy and severe comorbidities. We aim to evaluate the outcomes of BITA versus single internal thoracic artery (SITA) grafting in elderly patients. Methods and Results A meta-analysis was performed by database searching until May 2021. Studies comparing BITA and SITA grafting among elderly patients were included. One randomized controlled trial, nine propensity score matching and six unmatched studies were identified, with a total of 18,146 patients (7,422 received BITA, and 10,724 received SITA). Compared with SITA, BITA grafting had a higher risk of deep sternal wound infection (DSWI) (OR: 1.67; 95% CI, 1.22-2.28), and this risk could not be significantly reduced by skeletonized technique. Meanwhile, BITA grafting was associated with a higher long-term survival (HR: 0.83; 95% CI, 0.77-0.90), except for the octogenarian subgroup. Reconstructed Kaplan-Meier survival curves revealed 4-year, 8-year and 12-year overall survival rates of 85.5%, 66.7%, and 45.3%, respectively, in the BITA group and 79.3%, 58.6%, and 34.9%, respectively, in the SITA group. No significant difference was observed in early mortality, perioperative myocardial infarction, perioperative cerebral vascular accidents or re-exploration for bleeding. Conclusions Compared with SITA, BITA grafting could provide a long-term survival benefit for elderly patients, though this benefit remained uncertain in octogenarians. Meanwhile, elderly patients recieved BITA were associated with a higher risk of DSWI and such a risk could not be eliminated by the skeletonized technique.

Correspondence on Should the Ravitch Procedure to Correct Pectus Excavatum Be Avoided in Young Children?

“…It’s well known that cardiac surgeons are afraid of using both mammary arteries for coronary artery grafting because of concerns over sternal devascularization and a higher risk of deep sternal wound infection [ 4 ].…”