Myocardial revascularization using the arterial T graft: which conduit should be chosen for the free graft?
Calin Vicol1, Stephan Raab, Michael Beyer
1Herzchirurgische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Klinikum Grosshadern, München, Germany. cvicol@belios.uni-muenchen.de
Insights
The right internal thoracic artery (RITA) is suitable for male patients with reduced heart function, while the radial artery is preferred for smaller women needing multiple grafts. Both show comparable long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Grafting
Background:
- The T graft procedure involves implanting a free arterial graft to the internal thoracic artery.
- Optimal conduit selection for free arterial grafts remains under investigation.
Purpose of the Study:
- To compare the efficacy and outcomes of using the right internal thoracic artery (RITA) versus the radial artery as a free graft in T graft procedures.
Main Methods:
- A comparative study involving two patient groups: Group I (n=129) using RITA as a free graft, and Group II (n=84) using the radial artery.
- Patient characteristics, early and late mortality, morbidity, graft patency, and angina recurrence were assessed.
Main Results:
- RITA was more frequently used in male patients and those with reduced left ventricular ejection fraction.
- No significant differences in early or late mortality and angina recurrence were observed between the RITA and radial artery groups.
- Graft patency rates were high in both groups (90.9% for RITA, 93.1% for radial artery).
Conclusions:
- The right internal thoracic artery (RITA) is recommended for tall men and patients with reduced ejection fraction, diabetes, or obesity.
- The radial artery is advised for small women, particularly those at high risk of bleeding or requiring multiple coronary anastomoses.
Background:
The T graft is achieved by the end-to-side implantation of a free arterial graft into the left internal thoracic artery, which remains in situ. Which conduit is best suited as the free graft is still being discussed.
Methods:
Two groups of patients are compared. The right internal thoracic artery (RITA) was used as a free graft in group I (n = 129), and the radial artery was used in group II (n = 84).
Results:
The RITA was used more often with male patients (P < .02) and with patients presenting a reduced left ventricular ejection fraction (P < .03). The average number of coronary anastomoses per patient was higher in group II than in group I (P < .002). There were no significant differences between the groups in early mortality (0.8% in group I and 1.2% in group II) and morbidity. Postoperative chest tube output was significantly higher in group I than in group II (P < .05). The mean follow-up time was 35.2 +/-28.3 months. There were no significant differences regarding late mortality (6.9% in group I and 5.3% in group II) and the recurrence of angina (group I, 6 cases or 5.5%; group II, 3 cases or 4.2%). Because of the recurrence of angina or questionable chest pain in 22 patients, angiography was performed, and results showed a patency rate of 90.9% in group I and 93.1% in group II.
Conclusions:
Based on our experience, we advise using the RITA as a free graft with tall men and also in patients with a reduced left ventricular ejection fraction, diabetes, and obesity. The radial artery should be used with small women if there is a high risk of bleeding and if several coronary anastomoses are necessary.
