Early and long-term outcomes of bilateral internal mammary artery versus radial artery grafting: A national cohort study.

Authors

Juan A Montero, Santiago Cubas, Maximiliano Hernandez, Carolina Sosa, Gerardo Soca, Víctor Dayan

Published in

JTCVS open. Volume 32. Pages 101883. Epub Jun 06, 2026.

Abstract

To compare early and long-term outcomes of bilateral internal mammary artery (BIMA) grafting versus left internal mammary artery (LIMA) plus radial artery (RA) grafting in patients undergoing isolated coronary artery bypass grafting (CABG).
This retrospective national cohort study included patients undergoing isolated CABG with multiarterial grafting in Uruguay between 2002 and 2022. Patients undergoing BIMA grafting or LIMA+RA grafting were identified from a mandatory national cardiac surgery database. Propensity score matching with multiple imputation was used to balance baseline characteristics between the 2 groups. Long-term survival was assessed using Kaplan-Meier analysis, Cox proportional hazards models, and restricted mean survival time (RMST). Competing-risk regression (Fine-Gray) was used to evaluate repeat percutaneous coronary intervention. Effect modification by sex and diabetes was explored.
Among 2882 patients (2132 BIMA and 750 LIMA+RA), 4203 matched (with replacement) patients were analyzed. At 10 years, RMST did not differ between groups (9.06 years for BIMA vs 8.98 years for LIMA+RA; P = .36), and BIMA grafting was associated with improved long-term survival (hazard ratio, 0.73; 95% confidence interval, 0.55-0.93; P = .03) which was not supported by sensitivity analyses. There was no interaction with sex or with diabetes. BIMA grafting was associated with lower operative mortality but with a higher rate of mechanical ventilation and longer duration of inotrope use. No between-group differences were observed in major ischemic events, deep sternal wound infection, or repeat revascularization.
In this national cohort, BIMA grafting improved early outcomes but did not confer a consistent overall long-term survival advantage compared with LIMA+RA grafting. A lack of support from sensitivity analyses implies the need for an individualized approach.

PMID:
42604324
Bibliographic data and abstract were imported from PubMed on 16 Aug 2026.

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