Long-term results of bilateral internal thoracic artery grafting

Little is known about the long-term results of the uniform group of patients who had bilateral internal thoracic artery (ITA) grafting with the method of left ITA-to-left anterior descending coronary artery and right ITA-to-circumflex artery.

Late follow-up study was performed in the first consecutive 203 patients (mean age, 62.6 +/- 9.1 years) who underwent isolated coronary artery bypass grafting with the left ITA anastomosed to the left anterior descending coronary artery and the right ITA to major branches of the circumflex artery. The patients were grouped according to the patency of ITA grafts demonstrated by early postoperative angiography (Both patent (BP) group, 168 patients: both ITAs showed complete patency; Not patent (NP) group, 23 patients: at least one ITA was dysfunctional).

Actuarial 7-year survival in all patients was 89.3% +/- 3.1%. The cumulative probability of event-free survival for cardiac death, myocardial infarction, intervention, and angina at 7 years was 96.6% +/- 1.8%, 98.0% +/- 1.5%, 86.7% +/- 3.2%, and 90.7% +/- 2.9%, respectively. NP group had more myocardial infarction and angina than the BP group, but was not statistically significant. Because of failed grafts at the early angiography, intervention was performed more frequently in NP group (p < 0.01).

Our results of actuarial 7-year survival and the cumulative probability of event-free survival were at least comparable to the results of other similar studies using bilateral ITA. The freedom from angina appeared to be better than in the previous study. Overall our study supports the continued use of this method of ITA grafting.