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Long-term angiographic evaluation of free internal thoracic artery grafting for myocardial revascularization
S Yamashiro1, R Sakata, Y Nakayama
1Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.
Insights
Free internal thoracic artery grafting shows excellent long-term patency and survival rates comparable to in situ grafts for coronary artery bypass surgery. This technique offers a viable alternative for cardiac revascularization.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Grafting
Background:
- Internal thoracic artery (ITA) grafting is crucial for coronary artery bypass (CAB).
- Comparing free ITA grafts versus in situ ITA grafts is essential for optimizing surgical outcomes.
Purpose of the Study:
- To evaluate the usefulness of free internal thoracic artery (fITA) grafting.
- To compare postoperative graft patency and long-term results of fITA grafts versus in situ ITA grafts.
Main Methods:
- Retrospective analysis of 41 patients undergoing fITA grafting (1990-1998).
- Comparison of graft patency and long-term survival/cardiac event-free rates with in situ ITA grafts.
- Assessment of luminal diameter changes in fITA grafts via serial angiography for patients followed >5 years.
Main Results:
- Early postoperative patency rate for fITA grafts was 95.2%, with all remaining patent long-term.
- At 9 years post-surgery, fITA recipients showed 100% survival and 77.5% cardiac event-free rate.
- Mean luminal diameter enlargement of 0.57 mm and a 27.8% increase in mean matching rate were observed in fITA grafts.
Conclusions:
- Free internal thoracic artery grafting demonstrates excellent long-term patency and durability.
- fITA grafting provides long-term clinical outcomes comparable to in situ ITA grafting for coronary artery bypass.
- fITA grafting is a valuable and effective surgical option for coronary revascularization.
Abstract:
Between 1990 and 1998, 41 patients underwent free internal thoracic artery grafting for coronary artery bypass. To investigate usefulness of free internal thoracic artery grafting, we compared the postoperative graft patency of free internal thoracic artery grafts with that of in situ internal thoracic artery grafts, and compared the long-term results such as actual survival and cardiac-event free rate in patients receiving free internal thoracic artery grafts with those results in patients receiving in situ internal thoracic artery grafts. Postoperative changes in luminal diameter of free internal thoracic artery grafts were calculated as the difference between the first and secondary angiographic evaluation in 17 patients who were followed-up for more than 5 years. The early postoperative graft patency rate of free internal thoracic artery was 95.2%. All these early patent grafts remained patent at the time of the late study. At 9 years post-surgery, patients who received free internal thoracic artery grafts had a survival rate of 100% and a cardiac event-free rate of 77.5%; the luminal diameter enlargement was 0.57 mm, and the mean matching rate increased 27.8%. We conclude that the free internal thoracic artery provides long-term results comparable with those of in situ internal thoracic artery.