Coronary artery revascularization using both ITAs as free conduits in patients with three-vessel disease--the lambda...

There is little information on using internal thoracic arteries (ITA) as free conduits in coronary artery bypass grafting. This study examines the results using both ITAs as free grafts in a lambda configuration implanting the common trunk into the ascending aorta.

Over a 6-year period, 317 patients underwent coronary artery revascularization with both ITAs as free grafts in a lambda configuration.

An average of 4.9 distal anastomoses per patient was performed. There were 4 deaths (three early and one late). The mean NYHA class improved from preoperatively 2.8 to 1.1 at the last check. All 16 patients with suspected recurrent angina or a pathologic exercise test were restudied by angiography. Segmental graft stenosis or occlusion was found in 13 (in only one at aortic anastomosis). Five patients underwent late PTCA, and two underwent coronary reoperation. The six-year actuarial survival was 98% (90 % CL+/- 2 %), intervention-free survival 96 % (90 % CL +/- 2 %).

Revascularization using both ITAs as free grafts in a lambda configuration gives good early and mid-term results for up to 6 years. The aortic ITA anastomosis can be considered safe.