Off-Pump Bilateral Versus Single Skeletonized Internal Thoracic Artery Grafting in High-Risk Patients

Background-We compared the outcomes in propensity score-matched high-risk patients (European System for Cardiac Operative Risk Evaluation [EuroSCORE] >= 5) undergoing off-pump coronary artery bypass graft surgery using bilateral or single skeletonized internal thoracic artery (ITA). Methods and Results-Of 794 consecutive patients undergoing isolated coronary artery bypass graft surgery (788 by the off-pump technique without emergent conversion to cardiopulmonary bypass), the 536 who had a EuroSCORE >= 5 and underwent off-pump skeletonized single (n = 236) or bilateral (n = 300) ITA were retrospectively analyzed after excluding the 6 who were transferred to our hospital after receiving percutaneous cardiopulmonary support, the 45 who had only 1 target in the left-side coronary area, and the 207 with EuroSCORE <5. A total of 235 pairs were matched using propensity scores calculated from 7 preoperative factors (C statistic, 0.65). The rate of postoperative complications was similar between the groups. The mean observation period was 3.2 years. The 5-year estimated survival rate free from overall death and cardiac event in patients receiving bilateral versus single ITA grafting was 85.8 +/- 5.5% versus 74.8 +/- 4.9% (P = 0.002) and 87.4 +/- 4.6% versus 66.1 +/- 5.7% (P = 0.001), respectively. In multivariate Cox proportional hazard models, bilateral ITA grafting was significantly associated with a lower risk of overall death (hazard ratio, 0.56; 95% CI, 0.32 to 0.87; P = 0.009) and cardiac event (hazard ratio, 0.40; 95% CI, 0.24 to 0.69; P = 0.001). Conclusions-In high-risk patients, off-pump skeletonized left-sided bilateral in situ ITA grafting is associated with lower risk of overall death and cardiac event than single ITA grafting without increased operative risk. (Circulation. 2011; 124[suppl 1]: S130-S134.)