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Bilateral internal thoracic artery T grafting for coronary artery revascularization. Angiographic assessment and
1Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-8558, Japan.
Insights
Bilateral internal thoracic artery T grafting shows excellent early results in coronary artery bypass grafting. This technique offers high graft patency and a 100% three-year survival rate for selected patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- Internal thoracic artery (ITA) grafts are associated with superior long-term patency compared to saphenous vein grafts.
- The use of bilateral ITA (BITA) T-grafting aims to maximize arterial revascularization.
Purpose of the Study:
- To evaluate the early and mid-term outcomes of bilateral internal thoracic artery T-grafting.
- To assess graft patency and patient survival following BITA T-grafting.
Main Methods:
- Retrospective study of 51 patients undergoing CABG with BITA T-grafting.
- The BITA T-graft involved anastomosing the free right ITA to the in-situ left ITA.
- Additional grafts included right gastroepiploic artery, radial artery, free left ITA, and saphenous vein grafts.
Main Results:
- Zero hospital mortality and no deep sternal infections.
- Stroke morbidity was 1.9%.
- High graft patency rates: 98% for in-situ left ITA and 96.4% for free right ITA.
- Mid-term angiography confirmed patent T-graft anastomoses.
- Three-year actuarial survival was 100%, with 96% freedom from cardiac events.
Conclusions:
- Bilateral internal thoracic artery T-grafting is a safe and effective technique for selected patients.
- The procedure demonstrates excellent early and mid-term clinical outcomes.
- High graft patency and survival rates support the use of BITA T-grafting.
Objectives:
We studied the early outcome of bilateral internal thoracic artery T grafting.
Methods:
Coronary artery bypass grafting was studied retrospectively using bilateral internal thoracic artery T grafting in 51 patients. The T graft was made by anastomosing the free right internal thoracic artery to the in-situ left internal thoracic artery. Average patient age was 63.5 +/- 9.9 years, and the average number of anastomoses per patient was 3.6 +/- 0.9. In 35 patients, the right gastroepiploic artery (21 anastomoses in 20 patients), radial artery (1 anastomosis), free left internal thoracic artery (1 anastomosis) and saphenous vein graft (14 anastomoses in 13 patients) were used as additional bypass conduits.
Results:
Hospital mortality was 0%. The morbidity of stroke was 1.9% (1 patient) and deep sternal infection 0%. Patency of the in-situ left internal thoracic artery was 49/50 anastomoses (98%) and that of the free right internal thoracic artery 81/84 anastomoses (96.4%). Mid-term coronary angiography in 7 patients demonstrated patent anastomosis of the T graft. Acute myocardial infarction unrelated to graft failure occurred in 2 patients during follow-up. Other patients were evaluated by exercise stress tests every year and none exhibited myocardial ischemia in the areas of T graft coronary revascularization. Three-year actuarial survival rate was 100% and freedom from cardiac events 96%.
Conclusions:
The bilateral internal thoracic artery T graft provides satisfactory early and mid-term outcomes in properly selected patients.