Better ischemic event-free survival after two internal thoracic artery grafts: 13 years of follow-up

Background. We researched our data to determine whether pedicled bilateral internal thoracic artery (BITA) grafting led to better ischemic event-free survival compared to single ITA grafting, at 10 years mean follow-up. Methods. Retrospectively 249 patients with BITAs with or without additional vein grafts (BITA group) were matched with 233 comparable patients with le ft ITA and additional vein grafts (LITA group), at a mean follow-up interva l of 10 years. Results. At 13 years, 76.2% +/- 5.9% of the BITA and 78.3% +/- 3.8% of the LITA patients were still alive (p = not significant). Death, recurrent angi na, new myocardial infarction, or coronary reinterventions occurred more of ten in LITA (49.4%) than BITA (33.3%) patients (p = 0.0004). The ischemic e vent-free survival estimates for BITA patients (47.5% +/- 8.4%) was better than for LITA patients (35.4% +/- 5.1%) (p < 0.001). Multivariate analysis showed that BITA was a predictor for ischemic event-free survival (p = 0.00 05). Conclusions. For the decision to use one or two ITAs the positive influence of BITA grafting on ischemic event-free survival is more important than it s effect on survival, per se. Compared to the general strategy of BITA graf ting, neither total arterial revascularization nor the specific vessels gra fted with BITA is relevant for the ischemic event-free survival. (C) 2001 b y The Society of Thoracic Surgeons.