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 left ITA and additional vein grafts (LITA group), at a mean follow-up interval 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 angina, new myocardial infarction, or coronary reinterventions occurred more often in LITA (49.4%) than BITA (33.3%) patients (p = 0.0004). The ischemic event-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 = 0.0005). 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 its effect on survival, per se. Compared to the general strategy of BITA grafting, neither total arterial revascularization nor the specific vessels grafted with BITA is relevant for the ischemic event-free survival.