Observed Versus Expected Survival After Exclusive Off-Pump BITA CABG: A 20-Year Cohort Analysis
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0144
Submission Type:
Abstract Submission
Authors:
Daniel Navia (1), Mariano Vrancic (1), Fernando Piccinini (1), Ivan Huespe (2), Leandro Seoane (1), Juan Costabel (1), Alberto Dorsa (1), Marcelo Trivi (1)
Institutions:
(1) ICBA, CABA, Buenos Aires, (2) Hospital Italiano, CABA, Buenos Aires
Submitting Author:
*Daniel Navia
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Co-Author(s):
Mariano Vrancic
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Fernando Piccinini
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ICBA
Ivan Huespe
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Hospital Italiano
Hospital Italiano
Leandro Seoane
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ICBA
Juan Costabel
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ICBA
Alberto Dorsa
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ICBA
Marcelo Trivi
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ICBA
ICBA
Presenting Author:
*Daniel Navia
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Abstract:
Objective
Bilateral internal thoracic artery (BITA) grafts are associated with superior long-term patency and reduced late mortality. Nevertheless, no investigation has benchmarked long-term outcomes of off-pump BITA coronary artery bypass grafting (CABG) against national life expectancy in a middle-income country. This study aimed to determine whether BITA grafting normalizes life expectancy.
Methods
We included all adults undergoing exclusive off-pump BITA CABG in "T graft" configuration, for multivessel disease at a tertiary center (2003–2023). Patients were followed through hospital registries and telephone contact. Observed survival was compared with age-, sex-, and calendar-matched national life-table survival (National Institute of Statistics) using the Ederer II relative survival method. Cox proportional hazards regression models were applied to compare time to death according to age and diabetic status. Also, we assess the need of postoperative angiography (PO-angio) at follow-up with a cumulative incidence function (CIF), treating death as a competing event.
Results
Among 4,495 patients (mean age 64 ± 9 years; 8.3% women; 31,475 patient-years; 1,199 deaths), relative survival matched the background population at 1 year (1.00; 95% CI 0.99–1.01), peaked at 10 years (1.13; 1.09–1.18), and remained 0.99 (0.89–1.09) at 20 years. By sex, men (n=4,120) showed sustained benefit-relative survival 1.10 at 10 years and 1.04 at 15 years-whereas women (n=375) fell below unity by year 8 and to 0.52 at 20 years, reflecting excess mortality (Figure 1). Age ≥65 years and diabetes were independently associated with higher postoperative mortality (HR 4.99; 95% CI: 4.33–5.75; p<0.01 and HR 1.28; 95% CI: 1.10–1.48; p<0.0, respectively). Competing-risk analysis showed a low cumulative incidence of PO-angio: 1% at 1 year (95% CI 0.7–1.4%), 4.8% at 5 years (4.1–5.6%), 8.8% at 10 years (7.7–9.9%), and 14.7% at 20 years (13.0–16.5%). Graft patency rates were: LITA-LAD 95% (N=318), RITA-CX 90% (N=302), and RITA-RCA 83% (N=278), with no sex differences.
Conclusions
In this 20-year cohort, men undergoing exclusive off-pump BITA CABG achieved survival comparable to the general population. Women, however, experienced persistent excess mortality, as well as patients older than 65 years and with diabetes. PO-angio remained below 15% at 20 years in both sexes, confirming the durability of BITA grafting in a middle-income country.
Bilateral internal thoracic artery (BITA) grafts are associated with superior long-term patency and reduced late mortality. Nevertheless, no investigation has benchmarked long-term outcomes of off-pump BITA coronary artery bypass grafting (CABG) against national life expectancy in a middle-income country. This study aimed to determine whether BITA grafting normalizes life expectancy.
Methods
We included all adults undergoing exclusive off-pump BITA CABG in "T graft" configuration, for multivessel disease at a tertiary center (2003–2023). Patients were followed through hospital registries and telephone contact. Observed survival was compared with age-, sex-, and calendar-matched national life-table survival (National Institute of Statistics) using the Ederer II relative survival method. Cox proportional hazards regression models were applied to compare time to death according to age and diabetic status. Also, we assess the need of postoperative angiography (PO-angio) at follow-up with a cumulative incidence function (CIF), treating death as a competing event.
Results
Among 4,495 patients (mean age 64 ± 9 years; 8.3% women; 31,475 patient-years; 1,199 deaths), relative survival matched the background population at 1 year (1.00; 95% CI 0.99–1.01), peaked at 10 years (1.13; 1.09–1.18), and remained 0.99 (0.89–1.09) at 20 years. By sex, men (n=4,120) showed sustained benefit-relative survival 1.10 at 10 years and 1.04 at 15 years-whereas women (n=375) fell below unity by year 8 and to 0.52 at 20 years, reflecting excess mortality (Figure 1). Age ≥65 years and diabetes were independently associated with higher postoperative mortality (HR 4.99; 95% CI: 4.33–5.75; p<0.01 and HR 1.28; 95% CI: 1.10–1.48; p<0.0, respectively). Competing-risk analysis showed a low cumulative incidence of PO-angio: 1% at 1 year (95% CI 0.7–1.4%), 4.8% at 5 years (4.1–5.6%), 8.8% at 10 years (7.7–9.9%), and 14.7% at 20 years (13.0–16.5%). Graft patency rates were: LITA-LAD 95% (N=318), RITA-CX 90% (N=302), and RITA-RCA 83% (N=278), with no sex differences.
Conclusions
In this 20-year cohort, men undergoing exclusive off-pump BITA CABG achieved survival comparable to the general population. Women, however, experienced persistent excess mortality, as well as patients older than 65 years and with diabetes. PO-angio remained below 15% at 20 years in both sexes, confirming the durability of BITA grafting in a middle-income country.
ADULT CARDIAC:
Coronary Artery Disease
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