Coronary Artery Bypass Grafting Using Bilateral Internal Thoracic Artery Grafting in Elderly; Early Morbidity and Mortality

Background: Myocardial revascularization is effectively achieved through coronary artery bypass grafting (CABG), which typically involves surgical anastomosis of the left internal thoracic artery (ITA) to the left anterior descending (LAD) artery. Additionally, a reversed saphenous vein graft is often used to revascularize other diseased coronary vessels. For improved long-term survival and preservation of cardiac function, bilateral ITA (BITA) grafting has demonstrated superiority over single ITA (SITA) grafting. However, the routine use of BITA is generally limited to younger patients, due to its association with prolonged operative time, greater technical complexity, and an increased risk of sternal wound complications, particularly in older or comorbid individuals. Objective: This study aimed to estimate the early morbidity and mortality, in addition to sternal complications incidence in elderly cases undergoing BITA grafting. Patients and Methods: This retrospective observational comparative cohort study included 126 elderly patients at Cairo University Hospitals. Cases were divided into 2 groups: Group A: underwent SITA grafting with saphenous vein graft (SVG) and group B: underwent BITA ± SVG grafting. Results: Group B had significantly increased sinus rhythm spontaneous recovery (P<0.001), and significantly decreased inotropic support, intra-aortic balloon pump (IABP), exploration, early and late pericardial effusion and posterior tamponade than group A (P<0.05). Group B had significantly shorter ICU stay, and hospital stay than group A (P<0.05). Early mortality and incidence of sternal wound complications was statistically insignificant between both groups. Conclusions: In elderly patients, BITA grafting is safe. Early morbidity and mortality are similar to conventional CABG. BITA grafting was linked to faster recovery, shorter hospital stay, and fewer complications. Using the skeletonization technique in harvesting BITAs lowered the probability of sternal wound infections.