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Should Bilateral Internal Thoracic Arteries be Used in Patients with Chronic Kidney Disease?

  • Author Footnotes
    1 Drs. Chaud and Kalavrouziotis contributed equally to this work and are both co-first authors.
    German J. Chaud
    Footnotes
    1 Drs. Chaud and Kalavrouziotis contributed equally to this work and are both co-first authors.
    Affiliations
    Department of Cardiac Surgery, and Research Center, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
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  • Author Footnotes
    1 Drs. Chaud and Kalavrouziotis contributed equally to this work and are both co-first authors.
    Dimitri Kalavrouziotis
    Footnotes
    1 Drs. Chaud and Kalavrouziotis contributed equally to this work and are both co-first authors.
    Affiliations
    Department of Cardiac Surgery, and Research Center, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
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  • Stéphanie Dionne
    Affiliations
    Department of Cardiac Surgery, and Research Center, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
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  • Samantha Guimaron
    Affiliations
    Department of Cardiac Surgery, and Research Center, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
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  • Manuel Roque Cervetti
    Affiliations
    Department of Cardiac Surgery, and Research Center, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
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  • Shervin Babaki
    Affiliations
    Department of Cardiac Surgery, and Research Center, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
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  • Siamak Mohammadi
    Correspondence
    Address reprint requests to Dr. Siamak Mohammadi MD, FRCSC, Department of Cardiac Surgery, Quebec Heart and Lung Institute, 2725 chemin Sainte-Foy, Quebec City, Quebec, Canada, G1V 4G5.
    Affiliations
    Department of Cardiac Surgery, and Research Center, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
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  • Author Footnotes
    1 Drs. Chaud and Kalavrouziotis contributed equally to this work and are both co-first authors.
      Preoperative renal dysfunction is a major determinant of operative and long-term mortality following cardiac surgery. The objective of this study was to assess early and long-term results of CABG in patients with preoperative chronic kidney disease (CKD) using a bilateral internal thoracic artery (BITA) strategy, compared to those without CKD. We retrospectively analyzed data for 2,111 consecutive patients who underwent CABG with BITA between 2000 and 2019. One-to-many propensity score matching was performed to produce a cohort of 132 patients with CKD (defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2), matched to 358 patients with normal renal function (non-CKD). The primary end-point of interest was late freedom from all-cause mortality. Late hospital readmissions were also assessed. Mean eGFR and serum creatinine were: 49.8 versus 84.3 mL/min/m2 and 146.1 versus 83.6 µmol/L (CKD vs non-CKD, P< 0.001). In-hospital outcomes were similar among matched patients, including mortality (CKD 0.8% vs non-CKD 0%, P= 0.31). At a median follow-up of 6.9 years, there was no significant difference in survival between both groups (hazard ratio (HR) 1.37, 95% confidence interval (CI) 0.87-2.16, P= 0.17). Hospital readmission for cardiovascular causes (including repeat coronary revascularization) was comparable between the 2 groups. However, the risk of hospital readmission for renal causes was higher in patients with CKD (6.7%) compared to non-CKD (1.2%). In a propensity score-matched cohort of patients undergoing BITA-CABG, CKD was not associated with increased early or late mortality, nor was there a greater risk of hospital readmission for cardiovascular events.

      Graphical abstract

      Keywords

      Abbreviations:

      AKI (acute kidney injury), BITA (bilateral internal thoracic artery), BMI (body mass index), CABG (coronary artery bypass grafting), CCS (Canadian Cardiovascular Society), CI (confidence interval), CKD (chronic kidney disease), COPD (chronic obstructive pulmonary disease), DSWI (deep sternal wound infection), eGFR (estimated glomerular filtration rate), HR (hazard ratio), IABP (intra-aortic balloon-pump), ICU (intensive care unit), IQR (interquartile range), ITA (internal thoracic artery), LVEF (left ventricular ejection fraction), MI (myocardial infarction), NYHA (New York Heart Association), PCI (percutaneous coronary intervention), SD (standard deviation), SMD (standardized mean difference)
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