Observational studyInterdisciplinary cardiovascular and thoracic surgery2026
Surgical Outcomes of in situ Internal Thoracic Artery Grafting in Patients with Ipsilateral Upper-Extremity Arteriovenous Fistulas.
Observational study in Interdisciplinary cardiovascular and thoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
10 authors.
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Abstract
objectivesThe use of in situ internal thoracic artery (ITA) grafts ipsilateral to upper extremity arterio-venous fistulas (UE-AVFs) during coronary artery bypass grafting (CABG) in dialysis-dependent patients raises concerns of coronary steal and compromised graft perfusion. However, the clinical significance of ITA-AVF laterality remains uncertain.
methodsWe retrospectively analysed dialysis-dependent patients who underwent CABG between February 2015 and December 2023 at 2 institutions. Patients with non-UE-AVF access, total vein grafting, or composite vein-artery configurations were excluded. The final cohort (N = 122) was divided into 2 groups: ipsilateral in situ ITA grafts (N = 66) and contralateral in situ or free ITA grafts (N = 56). The primary outcome was the incidence of major adverse cardiovascular and cerebrovascular events (MACCE); secondary outcomes included perioperative complications, haemodialysis-induced ischaemia, and 3-year survival.
resultsBaseline and operative characteristics were largely comparable between groups. Perioperative outcomes, including surgical site infection, 30-day mortality, and prolonged ventilation, showed no significant differences. Over a median follow-up of 2.4 years, MACCE occurred in 44% of patients (39% ipsilateral vs 50% contralateral/free ITA; P = .24), with no significant differences in 3-year mortality (29% vs 21%; P = .352). Multivariable analyses showed no association between ITA-AVF laterality and MACCE (adjusted odds ratio 0.68, P = .31) or 3-year mortality (adjusted hazard ratio 1.56, P = .291).
conclusionsIn this modestly sized retrospective cohort, ipsilateral in situ ITA grafting was not associated with significantly worse perioperative or long-term outcomes. Our findings should be interpreted as hypothesis-generating, and larger multicentre studies are needed to more definitively evaluate the safety of this grafting strategy in dialysis-dependent patients with UE-AVFs.
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