Optimal configuration for bypass of the left anterior descending artery during bilateral internal thoracic artery grafting.

Abstract Background The left internal thoracic artery (LITA) to left anterior descending (LAD) artery bypass remains the gold standard for coronary artery bypass graft (CABG) surgery. With the advent of bilateral ITA (BITA) grafting, optimal bypass configuration to the LAD is unclear. The objective of this study was to compare clinical outcomes between LITA-LAD and RITA-LAD configurations in BITA grafting. Methods The primary outcome was need for percutaneous or surgical re-intervention of the LAD. Secondary outcomes included all-cause mortality and cardiac mortality. Cox proportional hazard and competing risk models were used with entropy weighting. Results Among BITA patients, 1527 had LITA-LAD and 523 RITA-LAD grafts. Before entropy weighting, RITA-LAD patients were older with more diabetes, PVD, LV dysfunction, more urgent status (p Conclusions Use of either LITA or RITA for LAD grafting during BITA revascularization has no effect on long-term all-cause or cardiac mortality or need for repeat revascularization of the LAD. Cardiac surgeons should be confident in using a RITA-LAD bypass during BITA grafting.