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J Thorac Cardiovasc Surg 2000;120:990-998
© 2000 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
From the Department of Cardiac Surgery, "G. D'Annunzio" University, Chieti, Italy.
Received for publication May 4, 2000. Revisions requested June 14, 2000; revisions received June 30, 2000. Accepted for publication July 18, 2000. Address for reprints: Antonio Maria Calafiore, MD, "G. D'Annunzio" University, Department of Cardiac Surgery, S. Camillo de'Lellis Hospital, Via C. Forlanini, 50, 66100 Chieti, Italy (E-mail: calafiore{at}unich.it).
Abstract
Background: We evaluated whether bilateral internal thoracic arteries provide the same long-term results when used as in situ grafts and as Y grafts.
Methods and Results: From October 1991 to February 2000, 1818 patients had bilateral internal thoracic arteries used as in situ (n = 1378, group A) or as Y grafts (n = 440, group B). The number of anastomoses per patient and the number of bilateral internal thoracic artery anastomoses per patient were higher in group B (3.1 ± 0.9 and 2.7 ± 0.9) than in group A (2.9 ± 0.8 and 2.2 ± 0.6) (both P < .001). The number of right internal thoracic artery anastomoses per patient rose from 1.0 ± 0.3 in group A to 1.4 ± 0.6 in group B (P < .001), and the number of sequential anastomoses per right internal thoracic artery graft rose from 4.1% to 34.3% (P < .001). Thirty-day mortality was 2.0% in group A versus 2.5% in group B (P = not significant). No difference in postoperative course was detected. Eight-year survivals were 95.8% ± 2.7% in group A versus 94.8% ± 4.0% in group B (P = not significant), and event-free survivals were 95.2% ± 2.9% in group A versus 93.6% ± 4.4% in group B (P = not significant). Early angiograms were obtained in 295 patients (945 anastomoses, 863 distal and 82 proximal Y grafts), 213 patients (611) in group A and 82 patients (334) in group B. Patency rate was 98.8% in group A and 96.0% in group B (P = not significant), whereas grade A patency rate was 97.2% in group A and 96.4% in group B (P = not significant). Late angiograms were obtained in 88 patients (25 in group A and 63 in group B) at a mean of 17.5 ± 18.4 months: patency rate was 100% in group A and 99.2 in group B (P = not significant), and grade A patency rate was 98.6% in group A and 98.8% in group B (P = not significant). No Y anastomosis was occluded or stenosed.
Comment: Survival, incidence of cardiac events, and angiographic patency in the early and late phases are similar for bilateral internal thoracic arteries used either in situ or as Y grafts. However, Y grafting with bilateral internal thoracic arteries increases the number of anastomoses per bilateral thoracic artery, as well as the flexibility of the right internal thoracic artery.
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D P Taggart Bilateral internal mammary artery grafting: are BIMA better? Heart, July 1, 2002; 88(1): 7 - 9. [Full Text] [PDF]
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E. Prifti, M. Bonacchi, G. Frati, P. Proietti, G. Giunti, and M. Leacche {lambda}graft with the radial artery or free left internal mammary artery anastomosed to the right internal mammary artery: flow dynamics Ann. Thorac. Surg., October 1, 2001; 72(4): 1275 - 1281. [Abstract] [Full Text] [PDF]
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O. Lev-Ran, D. Pevni, M. Matsa, Y. Paz, A. Kramer, and R. Mohr Arterial myocardial revascularization with in situ crossover right internal thoracic artery to left anterior descending artery Ann. Thorac. Surg., September 1, 2001; 72(3): 798 - 803. [Abstract] [Full Text] [PDF]
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B. W. Lytle Skeletonized internal thoracic artery grafts and wound complications J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 625 - 627. [Full Text] [PDF]
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