Work

Bilateral internal thoracic artery grafting in isolated coronary artery bypass grafting: A 35-year experience

Year: 2025

Type: article

Abstract: Objectives: The study objectives were to analyze trends in bilateral internal thoracic artery grafting during isolated coronary artery bypass grafting over a 35-year interval and compare outcomes between bilateral internal thoracic artery and non-bilateral internal thoracic artery strategies. Methods: A cohort of 15,991 patients underwent isolated multivessel coronary artery bypass grafting at our institution between 1990 and 2024. Trends in bilateral internal thoracic artery, radial artery, and left internal thoracic artery + saphenous vein graft were assessed using chi-square tests with Bonferroni correction. Changes in obesity and diabetes prevalence across intervals were also analyzed. Propensity score matching (1:1) yielded 2013 pairs for outcome comparisons between bilateral internal thoracic artery and non-bilateral internal thoracic artery groups. Results: < .001), whereas cardiopulmonary bypass and crossclamp durations remained similar. Wound-healing complication rates did not increase with bilateral internal thoracic artery grafting. Kaplan-Meier analysis showed superior 30-year survival for bilateral internal thoracic artery compared with other grafting strategies. Conclusions: Bilateral internal thoracic artery grafting remains underused, particularly in recent years, despite demonstrated survival benefits and comparable wound-healing risks. The decline is not explained by patient risk factors, highlighting the need for broader adoption of bilateral internal thoracic artery grafting and further randomized trials to optimize coronary artery bypass grafting strategies.

Source: JTCVS Open

DOI: 10.1016/j.xjon.2025.09.040