Bilateral Internal Thoracic Artery Grafting: Does Graft Configuration Affect Outcome?

Monday, March 14, 2016

Submitted by

Source

Source Name: Journal of Thoracic and Cardiovascular Surgery

Source URL: http://www.jtcvsonline.org/article/S0022-5223(16)00428-1/abstract

Author(s)

J. Trent Magruder, Allen Young, Joshua C. Grimm, John V. Conte, Ashish S. Shah, Kaushik Mandal, Christopher M. Sciortino, Kenton J. Zehr, Duke E. Cameron, Joel Price

The Hopkins group reviewed differential outcomes in close to 800 patients who had undergone bilateral IMA revascularization during CABG. The compared configurations included:

IS LITA-LAD and IS RITA-left coronary circulation
IS LITA-LAD and IS RITA-right coronary circulation
IS RITA-LAD and IS LITA-left coronary circulation
IS LITA-LAD and Composite RITA to anywhere

Outcomes analysis failed to detect a difference in outcome endpoints consisting of long-term survival or repeat revascularization among the four configurations.

Is this enough evidence to say that it does not matter which of the techniques you use?

Comments

Submitted by Hugh Paterson on Mon, 2016-03-21 00:39

This is an analysis of a highly selected group of patients who underwent BITA grafting by various configurations selected on indeterminate criteria but were generally based on coronary anatomy favorable to a particular configuration. The criteria varied over time and presumably between surgeons allowing overlap between groups but the criteria were not included in the analyses. In a highly select group of patients in whom appropriate graft configuration selection criteria are followed, there appears to be no substantial difference in outcomes between groups. The data from the composite graft group were limited to the extent that a statement of similar outcomes (non inferiority) cannot be considered to be valid. Most importantly, the favorable outcomes of all configurations should not be assumed if the importance of favorable coronary anatomy is ignored, as stated by Tatoulis et al. (Tatoulis J, Buxton BF, Fuller JA. The right internal thoracic artery: the forgotten conduit--5,766 patients and 991 angiograms. Ann Thorac Surg. 2011 Jul;92(1):9-15)