Bruce W. Lytle, MD, Eugene H. Blackstone, MD, Joseph F

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The Effect of Bilateral Internal Thoracic Artery Grafting on Survival During 20 Postoperative Years Bruce W. Lytle, MD, Eugene H. Blackstone, MD, Joseph F. Sabik, MD, Penny Houghtaling, MS, Floyd D. Loop, MD, Delos M. Cosgrove, MD The Annals of Thoracic Surgery Volume 78, Issue 6, Pages 2005-2014 (December 2004) DOI: 10.1016/j.athoracsur.2004.05.070 Copyright © 2004 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Comparison of matched pairs of patients receiving BITA and SITA grafts. The numbers of patients surviving at selected follow-up intervals are listed (p < 0.001). Each symbol represents a death, and vertical bars depict the 68% confidence limits (equivalent to one standard error) of Kaplan-Meier estimates. Solid lines, enclosed within 68% confidence limits, are parametric estimates. (BITA = bilateral internal thoracic artery; SITA = single internal thoracic artery.) The Annals of Thoracic Surgery 2004 78, 2005-2014DOI: (10.1016/j.athoracsur.2004.05.070) Copyright © 2004 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Hazard function curves demonstrate the increased risk of death associated with SITA grafting with increasing follow-up interval. Dashed lines are 68% confidence bands. (BITA = bilateral internal thoracic artery; SITA = single internal thoracic artery.) The Annals of Thoracic Surgery 2004 78, 2005-2014DOI: (10.1016/j.athoracsur.2004.05.070) Copyright © 2004 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Survival of matched pairs stratified by BITA and SITA according to normal or mildly impaired LVF (LVF normal/mild) or moderately or severely impaired left ventricular dysfunction (moderate/severe LVF). (BITA = bilateral internal thoracic artery; LVF = left ventricular function; SITA = single internal thoracic artery.) The Annals of Thoracic Surgery 2004 78, 2005-2014DOI: (10.1016/j.athoracsur.2004.05.070) Copyright © 2004 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Cumulative distribution of differences in survival between BITA and SITA for each patient in the study. The nonproportional hazard equations were solved twice for each patient, once as if the patient had SITA grafting and once as if the patient had BITA grafting. (BITA = bilateral internal thoracic artery; SITA = single internal thoracic artery.) The Annals of Thoracic Surgery 2004 78, 2005-2014DOI: (10.1016/j.athoracsur.2004.05.070) Copyright © 2004 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Predicted outcomes for patient subsets based on age and the presence or absence of LV dysfunction and noncardiac risk factors. (A) Patients with neither LV dysfunction nor risk factors had extremely good survival at 20 years and incrementally better survival with BITA grafting, although the differences were small. (B) Patients with LV dysfunction derived more benefit from BITA grafting, although overall survival was impaired. (C) Noncardiac risk factors influenced both groups negatively. (D) Combining LV dysfunction and noncardiac risk factors predicted extremely poor outcomes but still with some benefit from BITA grafting. (BITA = bilateral internal thoracic artery; LV = left ventricular; SITA = single internal thoracic artery.) The Annals of Thoracic Surgery 2004 78, 2005-2014DOI: (10.1016/j.athoracsur.2004.05.070) Copyright © 2004 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Three-dimensional depiction of risk factor profile, age, and duration of follow-up on predicted survival difference between BITA and SITA. (A) “Ideal” patient profile (red grid, and see Fig 5A) and combined cardiac and noncardiac morbidity profile (blue grid, and see Fig 5). (B) Cardiac morbidity patient profile (blue grid and see Fig 5B) and noncardiac morbidity profile (red grid and see Fig 5C). (BITA = bilateral internal thoracic artery; SITA = single internal thoracic artery.) The Annals of Thoracic Surgery 2004 78, 2005-2014DOI: (10.1016/j.athoracsur.2004.05.070) Copyright © 2004 The Society of Thoracic Surgeons Terms and Conditions