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Bilateral versus single internal thoracic artery grafting in hemodialysis patients

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Abstract

Background

The use of the bilateral internal thoracic arteries (BITAs) during myocardial revascularization reportedly provides a survival benefit over using a single internal thoracic artery (SITA). However, the advantages in chronic hemodialysis patients, who generally have multiple comorbidities, is unclear.

Methods

Outcomes of chronic hemodialysis patients who underwent isolated coronary artery bypass grafting (CABG) using a SITA with additional saphenous vein grafts (SVGs) (n = 33) or BITAs (n = 30) for left-side revascularization were retrospectively reviewed.

Results

With the exception of the rate of diabetes mellitus (SITA vs. BITA: 84.8% vs. 50.0%; p = 0.003), the two groups showed similar patient characteristics. Using the off-pump technique, revascularization was completed without manipulation of the ascending aorta in 45.7% of patients in the BITA group, whereas all patients in the SITA group required aortic manipulation (p < 0.001). Of note, the incidence of extensive aortic calcification (>50% of ascending aorta circumference) was not uncommon (14.3%). The in-hospital mortality (3.0% vs. 0%, p = 0.336) and complication rates (including deep wound infection, re-exploration and stroke) were similar in both groups. The 5-year estimated survival rates for freedom from overall death in the SITA and BITA groups were 42.4% and. 57.4%, respectively (p = 0.202).

Conclusions

BITA grafting was able to achieve revascularization with minimal manipulation of the diseased ascending aorta without increasing the complication rate. The long-term survival benefit of BITA grafting, however, was unclear in dialysis patients, especially because such patients have a relatively short life expectancy.

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Funding

No potential conflict of interest to disclose of the author, and co-authors.

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Authors and Affiliations

  1. Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan

    Hisaaki Munakata, Yoshiyuki Tokuda, Masato Mutsuga & Akihiko Usui

  2. Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan

    Kazuyoshi Tajima, Wataru Kato & Keisuke Tanaka

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  1. Hisaaki Munakata
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  2. Kazuyoshi Tajima
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  4. Keisuke Tanaka
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  7. Akihiko Usui
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Correspondence to Hisaaki Munakata.

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Munakata, H., Tajima, K., Kato, W. et al. Bilateral versus single internal thoracic artery grafting in hemodialysis patients. Gen Thorac Cardiovasc Surg 68, 768–773 (2020). https://doi.org/10.1007/s11748-019-01254-9

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  • DOI: https://doi.org/10.1007/s11748-019-01254-9

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