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Coronary arteries bypass grafting with use of both internal thoracic arteries
M Krejca1, A Bochenek, T S Pyt
11st Cardiac Surgery Department, Silesian Heart Center, Katowice, Poland.
The internal thoracic artery is a preferred conduit for bypass grafting. While the single ITA grafting has been universally accepted -- the use of both ITA's remains controversial. The risk factors analysis based upon assessment of operative results and mid-term functional follow-up was performed. The clinical applicability of transthoracic B-mode ultrasonic imaging and Doppler spectrum analysis in the postoperative evaluation of use of two ITA's was investigated. From January 1989 to January 1993, 97 patients received bilateral ITA and additional vein or RGEA grafts at Groby Road Hospital, Leicester, UK. There were 77 men (79.4%) and 20 women (20.6%) with mean age of 52.1+/-10.1 years. 19 cases were urgent. 14.4% of patients suffered from diabetes mellitus, 8.3% -- COAD and 46.6% did not work because of angina. The average number of anastomoses per patient was 3. The operative mortality was 4.1%. Complications included: reoperation for bleeding=3.2%, sternal infection=6.5%, IABP=2.1%. There were no evidence of perioperative myocardial infarction. 80 patients were followed-up for 26,5+/-13 months. 49 patients were in angina NYHA class I while preoperatively: 7. 1 patient was in NYHA class III while preoperatively there were 40 patients. Nearly twice more patients worked, and more than three times fewer patients did not worked because of angina, comparing to preoperative period. With the use of colour Doppler technique the blood flow was measured in 78.3% of left and 74% of right ITA's. The average flow in left ITA was: 46.4+/-17 ml/min and 41.7+/-17 ml/min in right ITA. The multivariate analysis for risk factors of bilateral ITA's grafting was performed. There were no risk factors for postoperative complications of bilateral internal thoracic arteries grafting in presented material. The risk of perioperative death is higher for patients with triple vessels disease than for patients with double vessels disease. Bilateral ITA grafting procedure has positive influence on patients working abilities. Percutaneous ultrasonic assessment of flow in ITA's used for bypass appears to be useful non-invasive investigation of their function.
The internal thoracic artery is a preferred conduit for bypass grafting. While the single ITA grafting has been universally accepted -- the use of both ITA's remains controversial. The risk factors analysis based upon assessment of operative results and mid-term functional follow-up was performed. The clinical applicability of transthoracic B-mode ultrasonic imaging and Doppler spectrum analysis in the postoperative evaluation of use of two ITA's was investigated. From January 1989 to January 1993, 97 patients received bilateral ITA and additional vein or RGEA grafts at Groby Road Hospital, Leicester, UK. There were 77 men (79.4%) and 20 women (20.6%) with mean age of 52.1+/-10.1 years. 19 cases were urgent. 14.4% of patients suffered from diabetes mellitus, 8.3% -- COAD and 46.6% did not work because of angina. The average number of anastomoses per patient was 3. The operative mortality was 4.1%. Complications included: reoperation for bleeding=3.2%, sternal infection=6.5%, IABP=2.1%. There were no evidence of perioperative myocardial infarction. 80 patients were followed-up for 26,5+/-13 months. 49 patients were in angina NYHA class I while preoperatively: 7. 1 patient was in NYHA class III while preoperatively there were 40 patients. Nearly twice more patients worked, and more than three times fewer patients did not worked because of angina, comparing to preoperative period. With the use of colour Doppler technique the blood flow was measured in 78.3% of left and 74% of right ITA's. The average flow in left ITA was: 46.4+/-17 ml/min and 41.7+/-17 ml/min in right ITA. The multivariate analysis for risk factors of bilateral ITA's grafting was performed. There were no risk factors for postoperative complications of bilateral internal thoracic arteries grafting in presented material. The risk of perioperative death is higher for patients with triple vessels disease than for patients with double vessels disease. Bilateral ITA grafting procedure has positive influence on patients working abilities. Percutaneous ultrasonic assessment of flow in ITA's used for bypass appears to be useful non-invasive investigation of their function.