P144. Observed Versus Expected Survival After Exclusive Off-Pump BITA CABG: A 20-Year Cohort Analysis
Presented During: Adult Cardiac Poster Session II
ICBA
Buenos Aires, Buenos Aires
Argentina - Contact Me
Daniel Navia M.D. Chief Cardiac Surgery Dept. at Instituto Cardiovascular, Buenos Aires Argentina. Former Fellow in Cardiac Surgery at Cleveland Clinic (89-92). AATS member. Special interest in: offpump CABG, Aortic and Mitral valves repair.
Monday, May 4, 2026: 9:00 AM - 4:00 PM
McCormick Place Lakeside Center
Room: Exhibit Hall, Poster Area
Description
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.
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
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.
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
Presentation Duration
There is no formal presentation for posters. Your poster will be on display on your assigned day from 9:00AM - 4:00PM
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ADULT CARDIAC
Coronary Artery Disease