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Coronary-coronary bypass using the internal thoracic artery: a sparing procedure of the arterial conduit
T Hirotani1, T Kameda, T Kumamoto
1Department of Cardiovascular Surgery, Saiseikai Central Hospital, Tokyo, Japan.
Insights
Coronary-coronary bypass grafting (C-CBG) using free internal thoracic arteries (ITAs) allows for bilateral ITA use. This technique effectively revascularizes the posterolateral myocardium with excellent graft patency.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Grafting
Background:
- Internal thoracic artery (ITA) is the preferred graft for coronary artery bypass grafting (CABG).
- Limited length of in situ right ITA (RITA) restricts its use for posterolateral myocardial revascularization.
- Free ITAs offer a potential solution for utilizing bilateral ITAs.
Purpose of the Study:
- To evaluate the feasibility and early outcomes of coronary-coronary bypass grafting (C-CBG) using free internal thoracic arteries (ITAs).
- To assess the potential of C-CBG in expanding the use of bilateral ITAs for myocardial revascularization.
Main Methods:
- Retrospective analysis of 17 patients undergoing C-CBG with free ITAs between March 1997 and May 1999.
- C-CBG was performed when RITA length was inadequate or distal ITA was unused.
- Early operative results and graft patency were analyzed.
Main Results:
- No perioperative mortality or angina post-C-CBG (mean follow-up 27.3 months).
- High graft patency rate (one occlusion out of all grafts), with no stenotic changes observed on postoperative angiography.
- Enabled bilateral ITA utilization in 75% of CABG patients during the study period.
Conclusions:
- Coronary-coronary bypass grafting (C-CBG) effectively expands the application of bilateral internal thoracic arteries (ITAs).
- This technique provides a viable alternative for revascularizing the posterolateral myocardium.
- C-CBG demonstrates promising early results and graft patency.
Background:
The internal thoracic artery (ITA) is well known to be the best conduit for coronary artery bypass grafting. However, the bilateral use of ITAs remains limited because in situ right ITAs (RITAs) do not possess an adequate length to be directed to the posterolateral myocardium. We thus considered using free ITAs for conduits between the two segments of the same coronary artery.
Methods:
From March 1997 to May 1999, 17 patients underwent coronary-coronary bypass grafting (C-CBG) using free ITAs. Early operative results were analyzed. C-CBG was indicated when the right ITA had an inadequate length or when a distal part of the ITA was left unused.
Results:
No patient died after C-CBG and none have experienced angina since C-CBG (mean follow-up period 27.3 +/- 19.8 months). Postoperative angiography was performed in all subjects at discharge. Only one coronary-coronary bypass graft was occluded, the other grafts were patent, and there were no stenotic changes. Bilateral ITAs were used in 75% of the patients undergoing CABG during the period of this study.
Conclusions:
C-CBG can expand the use of bilateral ITAs and can provide an alternative method for revascularization of the posterolateral myocardium.
