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Should Bilateral Internal Thoracic Artery Grafting be used in patients with Peripheral Vascular Disease
Yanai Ben-gal1, Rephael Mohr1, Zvi Raviv1, Amir Kramer1, Nahum Nesher1, Nadav Teich1, Yossi Teich1, Dimitri Pevni1, Benjamin Medalion2.
1Tel Aviv Sorasky Medical center, Tel Aviv, Israel, 2Rabin Medical Center, Petach Tiqva, Israel.

OBJECTIVE: Peripheral Vascular Disease (PVD) is known to be a significant risk factor for early as well as long term mortality after Coronary Artery Bypass Grafting (CABG). Potential survival benefit of using Bilateral Internal Thoracic Artery (BITA) grafting in this subset of patients is questionable due to their short life expectancy and the increased risk of sternal infection compared to operations incorporating Single Internal Thoracic Artery (SITA). The purpose of this study is to compare early and long term outcome of patients with PVD undergoing BITA grafting, to that of patients with PVD undergoing CABG with SITA and other conduits such as saphenous vein graft (SVG) or radial artery (RA) .
METHODS: Four hundred seventy one patients with PVD who underwent BITA grafting between 1996 and 2003 were compared with 268 patients who underwent CABG with SITA
RESULTS: Occurrence of female gender (22.9% vs. 31.7%, P= 0.000, in the BITA and SITA groups, respectively), diabetes (38.2% vs. 48.9%, P=0.003), emergency operation (15.1% vs. 22%, p= 0.012), chronic obstructive pulmonary disease (11% vs.24.3%, p=0.000) and chronic renal failure (10.6% vs. 19.5%, p= 0.001) was lower in the BITA group. On the other hand congestive heart failure (33.1% vs19.4%, P= 0.000), and recent myocardial infarction (29.9% vs. 18.7%, P= 0.000) were more prevalent among BITA patients. EuroSCORE of SITA patients was significantly higher (9.45 ± 3.1 vs. 7.68 ± 3.6, P= 0.000). Operative mortality (7% vs 8.6%, BITA vs. SITA), post operative stroke (5.3% vs. 4.1%) and sternal wound infections (3.2% vs. 3.4%) were not significantly different between groups. Mean follow-up was 8.85 ± 4.95 years. Ten year survival (Kaplan-Meier) of the SITA group was not significantly lower. (47.4% vs. 54.5%, log rank test p=0.168). Assignment to the SITA group was also associated with similar adjusted survival (p < 0.001, compared to the BITA group, COX model)
CONCLUSIONS: This large cohort study shows that, with selective use of BITA and SITA, long term outcome of SITA patients with PVD is not inferior than that of BITA patients.


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