# Impact of Bilateral and Single Internal Thoracic Artery Bypass Grafting on Postoperative Reverse Remodeling in Patients with End-Stage Ischemic Cardiomyopathy

## TL;DR

Using both internal thoracic arteries in heart bypass surgery leads to better heart function recovery in patients with severe heart disease.

## Contribution

Shows that bilateral internal thoracic artery grafting improves postoperative reverse remodeling in ischemic cardiomyopathy patients.

## Key findings

- BITA group showed a 33% reduction in LVESVI compared to 17% in SITA group at 6 months.
- BITA was significantly associated with postoperative left ventricular reverse remodeling.
- Postoperative LVESVI was significantly smaller in BITA group (49 vs. 63 ml/m²).

## Abstract

The internal thoracic artery (ITA) has shown increased production of nitric oxide, which has beneficial effects on ventricular remodeling, among conduits of coronary artery bypass grafting (CABG). However, little is known about the impact of bilateral ITA strategy on postoperative left ventricle (LV) reverse remodeling as compared with single ITA, especially in patients with severely impaired LV function.

We retrospectively reviewed 126 propensity-matched patients with advanced ischemic cardiomyopathy (ICM) (left ventricular ejection fraction <40%) who underwent isolated multiple CABG utilizing bilateral (BITA group; n = 65) or single (SITA group; n = 61) ITA. The primary endpoint was postoperative reduction in the indexed left ventricular end-systolic volume index (LVESVI). Baseline covariates were adjusted with propensity score-matching.

At baseline, there were no intergroup differences in LVESVI (78 vs. 78 ml/m2, P = 0.93) and EuroSCORE II score (3.0% vs. 2.8%, P = 0.70). At 6 months post-surgery, the BITA group reduced LVESVI to a greater degree than the SITA group (−33% vs. −17%, P <0.01), resulting in significantly smaller postoperative LVESVI (49 vs. 63 ml/m2, P = 0.03). Multivariable analysis showed that CABG with BITA (P = 0.011) was associated with postoperative LV reverse remodeling.

In patients with ICM undergoing CABG, the in situ BITA strategy was associated with greater reductions in postoperative LV volume.