• Takeshi Kinoshita, Tohru Asai, and Tomoaki Suzuki.
• Division of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Japan. Electronic address: kinotakekinotake@yahoo.co.jp.
• J. Thorac. Cardiovasc. Surg. 2015 Aug 1;150(2):315-21.e3.

BackgroundWe compared the outcomes in propensity score-matched patients who had chronic kidney disease (CKD) undergoing off-pump coronary bypass grafting, with either a bilateral or single skeletonized internal thoracic artery (ITA).MethodsOf 1254 consecutive patients undergoing isolated coronary bypass surgery (1248 by the off-pump technique without emergent conversion to cardiopulmonary bypass), the 1203 who received a skeletonized, single (n = 453) or bilateral (n = 750), ITA graft were enrolled, after excluding the 6 patients who received preoperative percutaneous cardiopulmonary support and the 75 who had only 1 target vessel in the left coronary area. A total of 412 pairs were matched using propensity scores. Kaplan-Meier analyses were used to assess all-cause and cardiac-related mortality, by CKD stage (assessed by glomerular filtration rate [GFR]: <30; 30-60; >60 mL/minute/1.73 m(2)). Multivariate Cox proportional hazard models were used to assess for association of bilateral grafting with mortality. A test for interaction of bilateral ITA grafting and estimated GFR was conducted.ResultsNo significant difference was found in the incidence of 30-day mortality, stroke, or deep sternal infection between the 2 groups. Although an advanced stage of CKD decreased overall survival, a benefit of bilateral ITA grafting for all-cause and cardiac-related mortality occurred relatively early in the follow-up period and was not influenced by CKD stage. Bilateral ITA grafting was independently associated with a lower risk of both all-cause and cardiac-related mortality in patients with an estimated GFR of <60. No interaction was found between bilateral ITA grafting and estimated GFR in either model.ConclusionsIn patients who have CKD, off-pump, skeletonized, left-side bilateral ITA grafting is associated with lower risk of all-cause and cardiac-related mortality, and does not increase operative risk.Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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