Outcomes of off-pump complete bilateral internal thoracic artery grafting in patients with multivessel coronary artery disease

Aim. To analyze inhospital and mid-term outcomes of offand on-pump complete bilateral internal thoracic artery (BITA) grafting in patients with multivessel coronary artery disease (CAD).

Material and methods. The article analyzed the immediate and mid-term (26 months) outcomes of BITA grafting in 178 patients with multivessel CAD. In 99 patients, there was on-pump conditions, and in 79 cases — off-pump. After nearest neighbor propensity score matching, without preliminary screening of unsuitable patients in the groups, 148 patients were selected, of which 2 groups with same sample size (n=74) were generated (off-pump and on-pump). The groups were comparable in terms of sex (p=0,483), age (p=0,061), body mass index (p=0,977), comorbidities, the number of hemodynamically significant coronary lesions (p=0,508), but there were significantly more patients with local ascending aortic calcification and significant extracranial artery stenosis (>60%) in the off-pump group (p=0,015 and p=0,039).

Results. The groups were comparable in the number of revascularized target coronary arteries (p=0,762), the incidence of inhospital complications. The mean follow-up period was 26 months. The long-term survival rate of patients was 93,7% in the ff-pump group and 93% in the on-pump group (p=0,807). Freedom from cardiovascular mortality was 100% in both groups, while freedom from adverse cardiovascular events was 98,4% in the off-pump group and 94% in the on-pump group (p=0,198).

Conclusion. Off-pump BITA grafting is an effective and safe method of surgical treatment of CAD, which allows for complete myocardial revascularization in patients with multivessel CAD and does not increase the complication rate during the inhospital period. In the period of up to 26 months, BITA grafting, regardless of the surgery conditions, was associated with high survival rate, complete freedom from cardiovascular mortality and high freedom from cardiovascular events.

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