Bilateral internal thoracic artery in situ versus y-composite graftings: five-year angiographic patency and long-term clinical outcomes

Abstract

Background: We compared 5-year graft patency rates and long-term clinical outcomes after off-pump coronary artery bypass grafting (OPCAB) using bilateral internal thoracic arteries (ITAs) as in situ grafts with those using bilateral ITAs as a Y-composite graft.

Methods: Of 398 patients who underwent OPCAB, bilateral ITAs were used as in situ grafts in 164 patients and as a Y-composite graft in 234 patients. A propensity score-matched analysis was used to match patients using bilateral ITA in situ grafts (group I, n=110) with patients using bilateral ITA Y-composite grafts (group Y, n=110). Postoperative early, 1-year, and 5-year angiographic patency rates and long-term clinical outcomes during follow-up of 104 (1 to 149) months were compared.

Results: There were no differences in operative mortalities (2 of 110 vs 1 of 110; p>0.999) and postoperative complications between groups I and Y. Early, 1-year, and 5-year postoperative angiographies showed no significant differences in bilateral ITA graft patency rates between groups I and Y (early, 98.2% vs 99.3%, p=0.450; 1-year, 92.5% vs 95.7%, p=0.138; 5-year, 92.5% vs 92.4%, p=0.978). No differences in overall survival (p=0.347) and freedom from cardiac death (p=0.780) rates were observed between the groups; 10-year freedom from cardiac death rates were 95.1% and 94.2% in groups I and Y, respectively. Reintervention-free survival (p=0.379) and major adverse cardiac event-free survival (p=0.338) rates were also similar between the groups.

Conclusions: The OPCAB using both bilateral ITA configurations demonstrated that there were no differences in terms of 5-year patency rates and long-term clinical outcomes between the groups.