Abstract
Background The frequent need of immediate institution of cardiopulmonary bypass because of ischemia
and increased risk of bleeding and longer duration of surgery limit the use of bilateral
internal thoracic artery (BITA) grafting in urgency.
Patients and Methods Of 4,525 consecutive patients with multivessel coronary artery disease who underwent
isolated coronary bypass surgery at the authors' institution (1999–September 2015),
121 (2.7%) patients had an operation before the beginning of the next working day
after decision to operate, which is the definition for emergency according to the
European System for Cardiac Operative Risk Evaluation II. BITA and single internal
thoracic artery (SITA) grafting were used in 52 and 46 of these patients, respectively;
venous grafts alone were used in the remaining cases. BITA and SITA patients were
compared as risk profiles, operative data, and outcomes. A propensity score (PS)-matched
analysis was also performed.
Results Between BITA and SITA patients, there was no significant difference as hospital mortality,
both in the overall (3.8 vs. 6.5%; p = 0.66) and the PS-matched series (0 vs. 4.3%; p = 1). Among the postoperative complications, only bleeding (but not blood transfusion
nor mediastinal re-exploration) was increased both in the overall (p = 0.037) and the PS-matched series of BITA patients (p = 0.092); duration of surgery was increased but not quite significantly (p = 0.12). Freedom from cardiac and cerebrovascular deaths, and major adverse cardiac
and cerebrovascular events were higher in PS-matched BITA patients, even though not
quite significantly (p = 0.11 for both).
Conclusion BITA grafting may be performed even in urgency. With respect to SITA grafting, hospital
mortality and postoperative complications other than bleeding are not increased; late
outcomes seem to be better.
Keywords
blood transfusion - coronary artery bypass grafting - CABG - outcomes - wound infection
