# Off-pump bilateral internal thoracic artery grafting in patients with left main coronary artery disease

## TL;DR

This study finds that using both internal thoracic arteries in heart surgery improves survival and reduces cardiac events compared to using just one artery.

## Contribution

The study demonstrates that bilateral ITA grafting improves long-term outcomes in patients with left main coronary artery disease.

## Key findings

- Bilateral ITA grafting was associated with 71.2% 10-year survival versus 60.6% with single ITA grafting.
- Bilateral ITA grafting reduced the risk of major adverse cardiac and cerebrovascular events by 32.9%.
- No significant differences were found in 30-day mortality or deep sternal wound infection rates between groups.

## Abstract

To compare postoperative outcomes in patients with left main coronary artery disease who underwent off-pump isolated coronary artery bypass grafting for multivessel disease using either skeletonized bilateral or single internal thoracic artery (ITA).

Among 1583 patients who underwent isolated coronary artery bypass grafting (CABG) in our hospital between 2002 and 2022, 604 patients with left main coronary artery disease underwent single (n = 169) or bilateral (n = 435) ITA grafting. We compared postoperative outcomes between the two groups after adjusting preoperative characteristics using inverse probability of treatment weighting.

After adjustment using inverse probability of treatment weighting method, the sum of weights was 599.74 in BITA group and 621.64 in SITA group. There was no significant difference in postoperative deep sternal wound infection (p = 0.227) and 30-day mortality (p = 0.612). Follow-up was completed in 98.7% (596/604) of the patients, and the mean follow-up duration was 6.7 years. At 10 years, the overall survival following bilateral versus single ITA grafting was 71.2% and 60.6%, respectively (log-rank test, p = 0.040), and freedom from major adverse cardiac and cerebrovascular events (MACCE) was 63.3% and 46.3%, respectively (log-rank test, p = 0.008). In multivariate Cox proportional hazard models, bilateral ITA grafting was significantly associated with a lower risk of all-cause death (hazard ratio [HR]: 0.706, 95% confidence interval [CI]: 0.504–0.987; p = 0.042) and MACCE (HR: 0.671, 95% CI: 0.499–0.902; p = 0.008).

Bilateral skeletonized ITA grafting is associated with lower rates of all-cause death and MACCE than single ITA grafting in patients with left main coronary artery disease undergoing off-pump CABG.

The online version contains supplementary material available at 10.1186/s13019-024-02582-5.