Routine use of bilateral internal thoracic artery grafting in women does not increase in-hospital mortality and could improve long-term survival

Abstract Background Bilateral internal thoracic artery (BITA) grafting is underused in women. Methods Outcomes of 798 consecutive women with multivessel coronary disease who underwent isolated coronary surgery (1999–2016) using BITA ( n =530, 66.4%) or single internal thoracic artery (SITA) grafting ( n =268, 33.6%) were reviewed retrospectively. Differences between BITA and SITA cohort were adjusted by propensity score matching. For both series, late survival was estimated with the Kaplan-Meier method. Results One-to-one propensity score matching resulted in 247 BITA/SITA pairs with similar baseline characteristics and risk profile. According to the propensity matching, BITA grafting was associated with a trend towards reduced in-hospital mortality (3.2% vs. 5.7%, p =0.19). However, BITA women had an increased chest tube output ( p =0.0076) as well as higher rates of any (13% vs. 5.3%, p =0.003) and deep sternal wound infections (9.3% vs. 4.9%, p =0.054), this translating in a longer in-hospital stay (10 vs. 9days, p =0.029). Test for interaction showed that body mass index >30kg/m 2 and extracardiac arteriopathy were associated with a higher risk of deep sternal wound infection in BITA than in SITA women (23.4% vs. 13.7%, p p =0.001, respectively). Freedom from all-cause death and cardiac or cerebrovascular death were improved in BITA cohort, even though the differences were not quite significant ( p =0.16 and 0.076, respectively). Conclusions When routinely performed, BITA grafting does not increase in-hospital mortality in women and could improve long-term survival. However, its use should be avoided in obese women with extracardiac arteriopathy because of increased risk of deep sternal wound infection.