SAN DIEGO – No differences in clinical outcomes or angiographic results were observed in off-pump coronary artery bypass patients who received bilateral internal thoracic arteries as in situ vs. as Y-composite grafts, a long-term single-center study showed.
"There have been reports that bilateral internal thoracic artery grafting [BITA] may improve long-term survival and freedom from reintervention," Dr. Ho Young Hwang said at the annual meeting of the Society of Thoracic Surgeons. "Previous studies have suggested that clinical results might be better with in situ BITA. Other studies have suggested that 8-year survival and 8-year event-free survival are similar between BITA as in situ vs. BITA as Y-composite grafts."
Dr. Ho Young Hwang
The purpose of the current study was to compare 5-year angiographic patency rates and long-term clinical outcomes in 398 patients who underwent off-pump coronary artery bypass at Seoul National University Hospital, Korea, between June 1998 and December 2003. Of the 398 patients, 164 received BITA as in situ grafts and 234 received BITA as Y-composite grafts. The mean age of patients at baseline was 62 years. The researchers selected 220 propensity score–matched patients for analysis (110 in the in situ graft group and 110 in the Y-composite graft group).
Dr. Hwang, of the hospital’s department of thoracic and cardiovascular surgery, reported that the rates of early mortality were similar between the in situ graft group and the Y-composite graft group (1.8% vs. 0.9%, respectively). The rates of postoperative complications were also similar between groups, with atrial fibrillation being the most common complication (13.6% vs. 17.3%, respectively).
The researchers performed early, 1-year, and 5-year postoperative angiographies in 217, 202, and 167 patients, respectively. They observed no significant differences in patency rates of BITA between the groups at 5 years (92.5% in the in situ graft group vs. 92.4% in the Y-composite graft group) or in the rate of overall 10-year survival (85.6% vs. 81.6%, respectively), 10-year freedom from cardiac death (95.1% vs. 94.2%), reintervention-free survival (86.3% vs. 82.5%), and freedom from major adverse cardiac events (83.2% vs. 80.3%).
Dr. Hwang said that he had no relevant financial conflicts to disclose.