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Failure of internal thoracic artery grafts: conclusions from coronary angiography mid-term follow-up
Eric Bezon1, Jean N Choplain, Yasser A Maguid
1Department of Cardiovascular and Thoracic Surgery, C.H.U. La Cavale Blanche, Brest, France. eric.benzon@chu-brest.fr
Insights
Internal thoracic artery bypass graft failures can be reduced by better surgical technique and preoperative analysis. Avoiding competitive blood flow and assessing coronary stenosis are key to improving graft patency.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Bypass Grafting
Background:
- Internal thoracic artery (ITA) bypass grafts are crucial in coronary artery revascularization.
- Understanding ITA graft failure mechanisms is essential for improving patient outcomes.
Purpose of the Study:
- To identify causes of internal thoracic artery bypass graft failures.
- To analyze failures based on operative technique, ITA used, and target coronary artery.
Main Methods:
- Retrospective analysis of 512 ITA bypass grafts in 302 patients.
- Utilized 302 follow-up angiographies performed at a mean of 17.3 months post-surgery.
- Included single, sequential, and Y-grafts with one or two ITAs.
Main Results:
- Overall graft failure rate was 6% (2% occlusion, 4% non-functioning).
- Left internal thoracic artery (LITA) grafts showed lower failure rates (4%) than right ITA grafts (13%).
- Anterior descending artery bypass grafts had lower failure rates (3%) than circumflex artery bypass grafts (13%).
Conclusions:
- Two-thirds of ITA graft failures could be preventable.
- Improved preoperative coronary angiography analysis and surgical technique mastery are critical.
- Competitive blood flow and distal coronary stenosis contribute to non-functioning grafts.
Background:
The objective of this study was to identify causes of the failures of internal thoracic artery bypass grafts according to operative technique, the internal thoracic artery used, and the coronary artery grafted.
Methods:
This retrospective study concerns 302 follow-up angiographies performed in patients treated with 512 internal thoracic artery bypass grafts: 115 single grafts, 78 sequential grafts, and 109 grafts with two internal thoracic arteries (61 Y grafts). Postoperative angiography was performed after a mean period of 17.3 +/- 4.1 months.
Results:
Failures consisted of 11 (2%) occluded grafts and 19 (4%) nonfunctioning grafts (threadlike internal thoracic artery). There was no difference in patency among the various types of left anterior descending artery bypass grafts anastomosed with the left internal thoracic artery. The failure rate was higher with the right internal thoracic artery (13%) than with the left internal thoracic artery (4%; p < 0.05). The failure rate of the left anterior descending artery bypass grafts (3%) was lower than that for the branches of circumflex artery bypass grafts (13%; p < 0.05). The 19 cases of nonfunctioning grafts did not include significant anastomotic stenosis: 14 were related to competitive blood flow, 4 to a poor recipient coronary arterial bed, and 1 to significant distal coronary stenosis.
Conclusions:
At least two thirds of failures of bypass grafts could have been avoided by more objective analysis of the coronary stenosis on preoperative coronary angiography and better mastery of the surgical technique.
