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Objectives <p>Benefits of bilateral internal mammary artery (BIMA) usage during coronary artery bypass grafting (CABG) are uncertain in patients with chronic kidney disease (CKD). We compare outcomes of BIMA versus single IMA (SIMA) for CKD patients.</p> Methods <p>A total of 422 patients underwent isolated primary CABG with BIMA (n = 134) or SIMA (n = 288) for triple-vessel disease at our center between 2015 and 2022. We defined CKD according to current guidelines (glomerular filtration rate &lt; 60&#xa0;ml/min per 1.73 m<sup>2</sup>). Patients with radial artery grafts, and no IMA graft were excluded. Inverse probability treatment weighting (IPTW) was used to reduce confounding variables. The primary endpoint was long-term survival, and secondary endpoint was cumulative incidence of major adverse cardiac or cerebrovascular event (MACCE): including all-cause mortality, stroke, myocardial infarction, revascularization, and rehospitalization for heart failure.</p> Results <p>The median age was 70.0 (IQR 63.0–77.0) years, and 296 patients (70.1%) were male. Median follow up time was 4.66&#xa0;years (IQR 4.41–5.11). IPTW yielded well-balanced cohorts. In IPTW-adjusted cohorts, operative mortality was comparable (BIMA; 0.4% vs. SIMA; 1.7%, <i>P</i> = 0.174) without differences in in-hospital complications (all <i>P</i> &gt; 0.05). Six-year survival was higher in BIMA grafting (74.0% [64.7–84.6%] vs. 62.8% [55.3–71.1%]; <i>P</i> = 0.044), which was supported by multivariable Cox regression analysis (Hazard ratio: 0.581, [0.353–0.927], <i>P</i> = 0.022). The incidence of MACCE was also lower in BIMA grafting (45.9% [33.4–56.0%] vs. 69.1% [59.6–76.4%], <i>P</i> &lt; 0.001).</p> Conclusion <p>Among patients with CKD patients requiring CABG, BIMA grafting may be associated with better long-term outcomes without increased operative risk.</p>

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Bilateral versus single internal mammary artery use in patients with chronic kidney disease

  • 期刊论文

  • 发表日期：

    2026年2月15日

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  • Yu Hohri,
  • Yanling Zhao,
  • Paul Kurlansky,
  • Iris Feng,
  • Christine Yang,
  • Gabriel Dardik,
  • Kavya Rajesh,
  • Hiroo Takayama,
  • Koji Takeda

摘要

Objectives

Benefits of bilateral internal mammary artery (BIMA) usage during coronary artery bypass grafting (CABG) are uncertain in patients with chronic kidney disease (CKD). We compare outcomes of BIMA versus single IMA (SIMA) for CKD patients.

Methods

A total of 422 patients underwent isolated primary CABG with BIMA (n = 134) or SIMA (n = 288) for triple-vessel disease at our center between 2015 and 2022. We defined CKD according to current guidelines (glomerular filtration rate < 60 ml/min per 1.73 m2). Patients with radial artery grafts, and no IMA graft were excluded. Inverse probability treatment weighting (IPTW) was used to reduce confounding variables. The primary endpoint was long-term survival, and secondary endpoint was cumulative incidence of major adverse cardiac or cerebrovascular event (MACCE): including all-cause mortality, stroke, myocardial infarction, revascularization, and rehospitalization for heart failure.

Results

The median age was 70.0 (IQR 63.0–77.0) years, and 296 patients (70.1%) were male. Median follow up time was 4.66 years (IQR 4.41–5.11). IPTW yielded well-balanced cohorts. In IPTW-adjusted cohorts, operative mortality was comparable (BIMA; 0.4% vs. SIMA; 1.7%, P = 0.174) without differences in in-hospital complications (all P > 0.05). Six-year survival was higher in BIMA grafting (74.0% [64.7–84.6%] vs. 62.8% [55.3–71.1%]; P = 0.044), which was supported by multivariable Cox regression analysis (Hazard ratio: 0.581, [0.353–0.927], P = 0.022). The incidence of MACCE was also lower in BIMA grafting (45.9% [33.4–56.0%] vs. 69.1% [59.6–76.4%], P < 0.001).

Conclusion

Among patients with CKD patients requiring CABG, BIMA grafting may be associated with better long-term outcomes without increased operative risk.