Related Experiment Videos
[Late results of coronary artery bypass grafting with the internal thoracic artery]
K Kawachi1, S Kitamura, R Morita
1Department of Surgery III, Nara Medical College.
Insights
Internal thoracic artery (ITA) grafts show superior long-term patency and survival rates compared to saphenous vein grafts (SVG) in coronary artery bypass grafting. This study highlights ITA
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- Graft selection, particularly the choice between internal thoracic artery (ITA) and saphenous vein grafts (SVG), significantly impacts long-term outcomes.
- Optimizing graft choice is crucial for improving patient survival and reducing cardiac events.
Purpose of the Study:
- To compare postoperative events, graft patency, and survival rates between patients receiving ITA grafts versus SVG-only grafts in isolated CABG.
- To evaluate the long-term efficacy of ITA grafts in a Japanese population undergoing CABG.
- To determine if ITA grafts offer enhanced long-term benefits compared to SVG grafts.
Main Methods:
- Retrospective analysis of 755 patients undergoing isolated CABG between November 1981 and December 1991.
- Comparison of outcomes between patients with at least one ITA graft (n=517) and those with only SVG grafts (n=238).
- Assessment of graft patency (overall and Graft-LAD specific), operative mortality, late cardiac events, and survival rates.
Main Results:
- ITA grafts demonstrated significantly higher patency rates than SVG grafts (97.1% vs. 85.6%, p<0.0001).
- Graft-LAD patency was also superior for ITA grafts (97.7% vs. 86.8%, p<0.0001).
- Patients with ITA grafts experienced fewer late cardiac events and had a better 8-year survival rate (91.1% vs. 85.3%, p=0.048).
Conclusions:
- The use of ITA grafts in CABG is associated with improved long-term graft patency and enhanced patient survival.
- ITA grafts provide significant long-term benefits over SVG-only grafts, including a reduced incidence of late cardiac events.
- This study provides the first evidence in a Japanese population supporting the superiority of ITA grafts for long-term CABG outcomes.
Abstract:
Between November 1981 and December 1991, 755 patients underwent isolated coronary artery bypass grafting. We compared postoperative events, graft patency and survival rates of the patients who received at least one internal thoracic artery graft (n = 517) with those of the patients who had only saphenous vein bypass grafts (n = 238). No significant difference was found between the 2 groups in patient's age at the operation, female ratio and the incidence of emergency operation. The operative mortality was not significantly different in either group. Graft patency was better for internal thoracic artery grafts than for SVG (ITA grafts 97.1%, SVG 85.6% p less than 0.0001). Graft-LAD patency rate was also better for ITA grafts than for SVG (ITA grafts 97.7%, SVG 86.8%, p less than 0.0001). The incidence of late cardiac events (late cardiac death, reoperation, myocardial infarction) is lower in patients with ITA. Furthermore, patients who received ITA grafts had a better survival rate at 8 years (91.1% versus 85.3%, p = 0.048) than those who had vein bypass grafts alone. We conclude that the use of ITA grafts enhances the long-term benefits including long-term survival rate. This is the first observation in Japanese population.