Does the Addition of a Gastroepiploic Artery to Bilateral Internal Thoracic Artery Improve Survival

It is unclear whether the additional conduit to supplement bilateral internal thoracic arteries (BITA) influences the patient outcome in coronary surgery. This retrospective study compared long-term survival of patients undergoing left-sided BITA grafting in which the third conduit to the right coronary system (RCA) was either vein graft (SVG) or gastroepiploic artery (GEA). From 1989 to 2014, 1432 consecutive patients underwent left-sided revascularization with BITA associated with SVG (n=599) or GEA (n=833) to RCA. Propensity score was calculated by logistic regression model and patients were matched 1 to 1 leading to two groups of 320 matched patients. The primary end point was the overall mortality from any cause. GEA was used in significantly lower risk patients. The 30-day mortality was 1.6% without influence of the graft configuration. Postoperative follow-up was 13.6 ± 6.6 years and was 94% complete. The significant difference in patients’ survival observed at 20 years in favour of GEA in unmatched groups (48±4% vs 33±6%, p