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J Thorac Cardiovasc Surg 1999;117:855-872
© 1999 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

TWO INTERNAL THORACIC ARTERY GRAFTS ARE BETTER THAN ONE

From the Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 8, 1998. Revisions requested June 10, 1998. Revisions received Jan 21, 1999. Accepted for publication Jan 22, 1999. Address for reprints: Bruce W. Lytle, MD, The Cleveland Clinic Foundation, F25, 9500 Euclid Ave, Cleveland, OH 44195. J Thorac Cardiovasc Surg 1999;117:855-72

Objective: Does the use of bilateral internal thoracic artery (ITA) grafts provide incremental benefit relative to the use of a single ITA graft?
Methods: We conducted a retrospective, nonrandomized, long-term (mean follow-up interval of 10 postoperative years) study of patients undergoing elective primary isolated coronary bypass surgery who received either single (8123 patients) or bilateral ITA grafts (2001 patients), with or without additional vein grafts. Multiple statistical methods including propensity score matching, and multivariable parsimonious and nonparsimonious risk factor analyses were used to address the issues of patient selection and heterogeneity.
Results: In-hospital mortality was 0.7% for both the bilateral and single ITA groups. Survival for the bilateral ITA group was 94%, 84%, and 67%, and for the single ITA group 92%, 79%, and 64% at 5, 10, and 15 postoperative years, respectively (P < .001). Death, reoperation, and percutaneous transluminal coronary angioplasty were more frequent for patients undergoing single rather than bilateral ITA grafting, and this observation remained true despite multiple adjustments for patient selection, sampling, and length of follow-up. The differences between the bilateral and single ITA groups were greatest in regard to reoperation. The extent of benefit of bilateral ITA grafting varied according to patient-related variables, but no patient subsets were identified for whom single ITA grafting could be predicted to provide an advantage.
Conclusions: Patients who received 2 ITA grafts had decreased risks of death, reoperation, and angioplasty. (J Thorac Cardiovasc Surg 1999;117:855-72)

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				A. Zacharias, R. H. Habib, T. A. Schwann, and C. J. Riordan Arterial versus vein graft patency in coronary artery bypass grafting patients with ischemia-directed repeat angiography Eur. J. Cardiothorac. Surg., September 1, 2005; 28(3): 510 - 511. [Full Text] [PDF]

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				H. Nishida, Y. Tomizawa, M. Endo, and H. Kurosawa Survival Benefit of Exclusive Use of In Situ Arterial Conduits Over Combined Use of Arterial and Vein Grafts for Multiple Coronary Artery Bypass Grafting Circulation, August 30, 2005; 112(9_suppl): I-299 - I-303. [Abstract] [Full Text] [PDF]

				J. Kobayashi, T. Tashiro, M. Ochi, H. Yaku, G. Watanabe, T. Satoh, O. Tagusari, H. Nakajima, S. Kitamura, and for the Japanese Off-Pump Coronary Revascularizati Early Outcome of a Randomized Comparison of Off-Pump and On-Pump Multiple Arterial Coronary Revascularization Circulation, August 30, 2005; 112(9_suppl): I-338 - I-343. [Abstract] [Full Text] [PDF]

				T. Fukui, S. Takanashi, Y. Hosoda, and S. Suehiro Total Arterial Myocardial Revascularization Using Composite and Sequential Grafting With the Off-Pump Technique Ann. Thorac. Surg., August 1, 2005; 80(2): 579 - 585. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, G. Di Giammarco, G. Teodori, A. L. Iaco, M. Pano, M. Contini, G. Vitolla, and M. Di Mauro Bilateral internal thoracic artery grafting with and without cardiopulmonary bypass: Six-year clinical outcome J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 340 - 345. [Abstract] [Full Text] [PDF]

				S.-W. Ryu, B.-H. Ahn, S.-J. Choo, K.-J. Na, Y.-K. Ahn, M.-H. Jeong, and S.-H. Kim Skeletonized Gastroepiploic Artery as a Composite Graft for Total Arterial Revascularization Ann. Thorac. Surg., July 1, 2005; 80(1): 118 - 123. [Abstract] [Full Text] [PDF]

				P. Saxena, R. Mejia, and R. Tam Hydrodissection Technique of Harvesting Left Internal Thoracic Artery Ann. Thorac. Surg., July 1, 2005; 80(1): 355 - 356. [Abstract] [Full Text] [PDF]

				R. H. Habib, A. Zacharias, T. A. Schwann, C. J. Riordan, S. J. Durham, and A. Shah Effects of Obesity and Small Body Size on Operative and Long-Term Outcomes of Coronary Artery Bypass Surgery: A Propensity-Matched Analysis Ann. Thorac. Surg., June 1, 2005; 79(6): 1976 - 1986. [Abstract] [Full Text] [PDF]

				E. Akinci, V. Erentug, K. Uzun, A. Polat, D. Goksedef, and C. Yakut Sequential Radial Artery Grafting Three-Vessel Coronary Artery Disease Asian Cardiovasc Thorac Ann, June 1, 2005; 13(2): 161 - 166. [Abstract] [Full Text] [PDF]

				P. J. Shah, K. Bui, S. Blackmore, I. Gordon, D. L. Hare, J. Fuller, S. Seevanayagam, and B. F. Buxton Has the in situ right internal thoracic artery been overlooked? An angiographic study of the radial artery, internal thoracic arteries and saphenous vein graft patencies in symptomatic patients Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 870 - 875. [Abstract] [Full Text] [PDF]

				S. G. Raja and G. D. Dreyfus Internal Thoracic Artery: To Skeletonize or Not to Skeletonize? Ann. Thorac. Surg., May 1, 2005; 79(5): 1805 - 1811. [Abstract] [Full Text] [PDF]

				P.-E. Falcoz, S. Chocron, C. Binquet, L. Stoica, D. Kaili, C. Quantin, and J.-P. Etievent Revascularization of the Right Coronary Artery: Grafting or Percutaneous Coronary Intervention? Ann. Thorac. Surg., April 1, 2005; 79(4): 1232 - 1239. [Abstract] [Full Text] [PDF]

				R. De Paulis, S. de Notaris, R. Scaffa, S. Nardella, J. Zeitani, C. Del Giudice, A. Penta De Peppo, F. Tomai, and L. Chiariello The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: The role of skeletonization J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 536 - 543. [Abstract] [Full Text] [PDF]

				L.M. Stevens, M. Carrier, L.P. Perrault, Y. Hebert, R. Cartier, D. Bouchard, A. Fortier, and M. Pellerin Influence of diabetes and bilateral internal thoracic artery grafts on long-term outcome for multivessel coronary artery bypass grafting Eur. J. Cardiothorac. Surg., February 1, 2005; 27(2): 281 - 288. [Abstract] [Full Text] [PDF]

				J. J. DeRose Jr, I. K. Toumpoulis, S. K. Balaram, J. P. Ioannidis, S. Belsley, R. C. Ashton Jr, D. G. Swistel, and C. E. Anagnostopoulos Preoperative prediction of long-term survival after coronary artery bypass grafting in patients with low left ventricular ejection fraction J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 314 - 321. [Abstract] [Full Text] [PDF]

				C. Hyun Kang, K.-B. Kim, C. Soo Park, J. Chul Paeng, and D. Soo Lee Improvement of Myocardial Stress Perfusion After Off-Pump Revascularization Using Bilateral Internal Thoracic In Situ Grafts Versus Y-Composite Grafts Ann. Thorac. Surg., January 1, 2005; 79(1): 93 - 98. [Abstract] [Full Text] [PDF]

				B. W. Lytle, E. H. Blackstone, J. F. Sabik, P. Houghtaling, F. D. Loop, and D. M. Cosgrove The Effect of Bilateral Internal Thoracic Artery Grafting on Survival During 20 Postoperative Years Ann. Thorac. Surg., December 1, 2004; 78(6): 2005 - 2014. [Abstract] [Full Text] [PDF]

				M. Tabata, S. Takanashi, T. Fukui, T. Horai, T. Uchimuro, K. Kitabayashi, and Y. Hosoda Off-Pump Coronary Artery Bypass Grafting in Patients With Renal Dysfunction Ann. Thorac. Surg., December 1, 2004; 78(6): 2044 - 2049. [Abstract] [Full Text] [PDF]

				O. M. Bical, W. Khoury, Y. Fromes, M. Fischer, M. Sousa Uva, G. Boccara, and P. H. Deleuze Routine Use of Bilateral Skeletonized Internal Thoracic Artery Grafts in Middle-Aged Diabetic Patients Ann. Thorac. Surg., December 1, 2004; 78(6): 2050 - 2053. [Abstract] [Full Text] [PDF]

				E. A Black, S. Ghosh, K. Sin, T. Spyt, and R. Pillai Off-Pump Coronary Artery Bypass Surgery Asian Cardiovasc Thorac Ann, December 1, 2004; 12(4): 379 - 386. [Abstract] [Full Text] [PDF]

				F. Formica, O. Ferro, P. Greco, A. Martino, D. Gastaldi, and G. Paolini Long-term follow-up of total arterial myocardial revascularization using exclusively pedicle bilateral internal thoracic artery and right gastroepiploic artery Eur. J. Cardiothorac. Surg., December 1, 2004; 26(6): 1141 - 1148. [Abstract] [Full Text] [PDF]

				G. Bisleri, T. Bottio, A. Manzato, and C. Muneretto Epidural anesthesia for coronary artery bypass surgery Eur. J. Cardiothorac. Surg., December 1, 2004; 26(6): 1228 - 1229. [Full Text] [PDF]

				M. A. Mariani, A. D'Alfonso, and J. G. Grandjean Total Arterial Off-Pump Coronary Surgery: Time to Change Our Habits? Ann. Thorac. Surg., November 1, 2004; 78(5): 1591 - 1597. [Abstract] [Full Text] [PDF]