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Myocardial revascularization with modified T-graft using bilateral internal thoracic arteries
1Department of Cardiothoracic Surgery, Westmead Hospital, Hawkesbury Rd, Westmead, NSW 2145, Australia.
Summary
This study shows that using bilateral internal thoracic arteries in a T-graft configuration can achieve total arterial revascularization for coronary artery bypass grafting. This method resulted in acceptably low perioperative morbidity and mortality in early surgical experience.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Complete arterial revascularization is a goal in myocardial revascularization surgery.
- Bilateral internal thoracic arteries (BITA) offer potential for total arterial grafting.
- The T-graft configuration allows utilization of BITA.
Purpose of the Study:
- To evaluate the perioperative morbidity and mortality associated with a modified T-graft technique using BITA.
- To assess the feasibility of achieving total myocardial revascularization with BITA T-grafts.
Main Methods:
- A consecutive series of 200 patients undergoing myocardial revascularization between October 1994 and April 1997.
- Utilized a T-graft configuration with BITA for coronary artery bypass grafting.
- Patients had stable or unstable angina pectoris; mean age 56 years, 171 males, 29 females, 43 with diabetes.
Main Results:
- Total arterial revascularization using BITA T-grafts was achieved in 95% of patients (190/200).
- The average number of anastomoses per patient was 4.2.
- 30-day mortality was 0.5%, with 1.0% experiencing perioperative myocardial infarction. Early re-operations were mainly for bleeding and sternal complications.
Conclusions:
- The T-graft configuration with BITA enables total arterial revascularization of the myocardium.
- This surgical approach is associated with acceptably low perioperative morbidity and mortality.
- BITA T-grafting is a viable option for myocardial revascularization.
