Sequential Grafting of the Left Internal Thoracic Artery to the Left Anterior Descending Artery and Graft Failure

BACKGROUND There is concern that left internal thoracic artery (LITA)-to diagonal (D)-to left anterior descending artery (LAD) grafts may be more susceptible to failure compared with single LITA-LAD grafts. METHODS Pooled individual patient data from 8 clinical trials with systematic graft imaging were analyzed to assess the incidence of sequential LITA-D-LAD vs single LITA-LAD grafts. Mixed-effects multivariable logistic regression, adjusting for patient characteristics and clustering within trials, was used. RESULTS Of 3969 patients with LITA-LAD grafts, 283 patients (7.1%) received sequential LITA-D-LAD grafts. Patients with sequential LITA-D-LAD grafts were older (66 vs 65 years, P = .009) and more often men (88% vs 83%, P = .03). Overall, graft failure occurred in 9.3% of patients with LITA-LAD grafts, with more graft failure occurring in single (9.5%) than in sequential LITA-D-LAD grafts (6.4%, P = .08) at a median time to imaging of 1.0 years (interquartile range, 1.0-1.1 years). After multivariable adjustment, sequential LITA-D-LAD grafting was not associated with graft failure (adjusted odds ratio, 1.22; 95% CI, 0.68-2.18; P = .55). There was no difference between groups in mortality (2.8% vs 5.3%, P = .06), myocardial infarction (1.4% vs 1.6%, P = .90), revascularization (4.5% vs 7.3%, P = .08), or stroke (1.7% vs 1.2%, P = .40). CONCLUSIONS In selected patients, LITA-D-LAD grafting was not associated with higher risk of graft failure or adverse clinical events at 1 year. (Ann Thorac Surg 2025;119:835-42) (c) 2025 by The Society of Thoracic Surgeons. Published by Elsevier Inc.