J Thorac Cardiovasc Surg 1997;114:686
© 1997 Mosby, Inc.
The right internal thoracic artery for myocardial revascularization
Luiz B. Puig, MD
University of São Paulo Medical School
Cardiopulmonary Department
São Paulo, Brazil
To the Editor:
We read with great interest the report by Ueyama and associates (J Thorac Cardiovasc Surg 1996;112:731-6) regarding revascularization of the posterolateral myocardial wall with the right internal thoracic artery (ITA) graft via the transverse sinus. This technique, published by us
1 in 1984 as a complementary method to use with the left ITA to the left anterior descending branch, provoked several comments concerning early morbidity, such as hemorrhage, mediastinitis, and late occlusion of the graft. On this subject, publications by Galbut, 2 Buche, 3 and Ueyama and colleagues, 4 as well as our own report, 5 show that the incidence of reoperation for bleeding ranged from 1.9% to 2.6% and mediastinitis from 0.9% to 2.6%, values normally found with any cardiac operation. The late patency rate of the right ITA through the transverse sinus and grafted to the circumflex artery or obtuse marginal branch ranged from 80.6% to 98%. 2, 3, 5 In our 233 patients who received both ITAs with or without saphenous vein grafts or the inferior epigastric artery, there were 49 late recatheterizations (average 61.9 months) and the patency of the grafts was as follows: 45 (92%) right ITA grafts, 47 (96%) left ITA grafts, and 19 (70%) saphenous vein grafts. In symptomatic patients with both ITAs patent, reoperation was never necessary. Only one patient required reoperation, 6 months after the original operation, because of the occlusion of the two ITAs. The great advantage of using ITAs or other arterial grafts for the left anterior descending branch and the obtuse marginal branch of the circumflex artery is to avoid late reoperation. We think that in due time we will choose the arterial graft most appropriate for each specific coronary artery. On the basis of our results, we continue to choose both ITAs for revascularization of the branches of the left coronary artery in patients up to 70 years of age who do not have excessive obesity, severe diabetes, or other important risk factors.
References
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Puig LB, Neto LF, Rati M, Ramires JAF, Luz PL, Pileggi F, et al. A technique of anastomosis of the right internal mammary artery to the circumflex artery and its branches. Ann Thorac Surg 1984;38:533-4.[Abstract]
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Galbut DL, Traad EA, Dorman MJ, DeVitt PL, Larsen PB, Kurlansky PA, et al. Coronary bypass grafting in the elderly. J Thorac Cardiovasc Surg 1993;106:128-36.[Abstract]
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Buche M, Schroeder E, Chenu P, Gurne O, Marchandise B, Pompilio G, et al. Revascularization of the circumflex artery with the pedicled right internal thoracic artery: clinical, functional, and angiographic midterm results. J Thorac Cardiovasc Surg 1995;110:1338-43.[Abstract/Free Full Text]
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Ueyama K, Sakata R, Umebayashi Y, Nakayama Y, Arakari K, Ura M. In situ right internal thoracic artery graft via transverse sinus for revascularization of posterolateral wall: early results in 116 cases. J Thorac Cardiovasc Surg 1996;112:731-6.[Abstract/Free Full Text]
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Gerola R, Puig LB, Moreira LFP, Cividanes GV, Gemha GP, Souto RCM, et al. Right internal thoracic artery through the transverse sinus in myocardial revascularization. Ann Thorac Surg 1996;61:1708-13.[Abstract/Free Full Text]
