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Early and long-term results of bilateral internal thoracic artery grafting in dialysis patients
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  • Yasuhiko Kawaguchi,
  • Hideki Kitamura,
  • Kazuya Konakano,
  • Mototsugu Tamaki,
  • Yasuhide Okawa
Yasuhiko Kawaguchi
Nagoya Heart Center
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Hideki Kitamura
Nagoya Heart Center
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Kazuya Konakano
Nagoya Heart Center
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Mototsugu Tamaki
Nagoya Heart Center
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Yasuhide Okawa
Nagoya Heart Center
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Abstract

Background: The benefits of bilateral internal thoracic artery (BITA) grafting during coronary artery bypass grafting in dialysis-dependent end-stage renal disease patients remain unclear. We compared the early and long-term effectiveness of coronary artery bypass using BITA versus single internal thoracic artery (SITA) grafting in this population. Methods: Eighty-nine consecutive patients with dialysis-dependent end-stage renal disease who underwent isolated coronary artery bypass grafting were retrospectively analyzed. Early and long-term results were reviewed, and univariate and multivariate analyses of risk factors for late death and major adverse cardiac events (MACE) was performed. Results: There was no significant difference between the BITA (n = 65) and SITA (n = 24) groups in in-hospital mortality (0% vs. 4.2%, p = 0.27) and the incidence of deep surgical wound infection (4.6% vs. 4.2%, p = 1.00). The overall survival rate in the BITA and SITA groups were 90.2% vs. 82.3%, 64.6% vs. 57.6%, and 51.8% vs. 20.6% at 1, 3, and 5 years, respectively. Overall survival was comparable but was more favorable in the BITA group (p = 0.08). MACE-free rate in the BITA and SITA groups were 96.6% vs. 90.2%, 87.4% vs. 60.6%, and 70.1% vs. 51.8% at 1, 3, and 5 years, respectively. The MACE-free rate was significantly higher in the BITA group (p = 0.04). Conclusions: While BITA grafting did not show a significant survival benefit over SITA grafting, it did not increase surgical complications and improve the MACE-free rate. BITA grafting may be a reasonable surgical strategy in dialysis-dependent patients.