Mid to long-term results of circumflex coronary artery revascularization with left internal thoracic artery grafts
Murat Mert1, Cenk Eray Yildiz, Alev Arat-Ozkan
1Departments of Cardiovascular Surgery, Istanbul University, Turkey.
Insights
Bilateral internal thoracic artery (ITA) grafting for coronary artery bypass surgery shows excellent long-term patency. Left ITA grafts to the circumflex artery demonstrate high success rates, making them ideal for revascularization.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Bilateral internal thoracic artery (ITA) grafting is increasingly used for left coronary artery revascularization.
- The right ITA typically targets the left anterior descending artery, while the left ITA is used for the circumflex system.
Purpose of the Study:
- To evaluate the mid to long-term patency of left ITA grafts anastomosed to the circumflex coronary artery.
- To assess the efficacy of bilateral ITA grafting in coronary artery bypass surgery.
Main Methods:
- A retrospective analysis of 40 patients who underwent bilateral ITA grafting between 1996 and 1998.
- Control coronary arteriography was performed at a median follow-up of 53 months to assess graft patency.
Main Results:
- The left ITA to circumflex artery anastomosis patency rate was 87.5% (35 out of 40 patients).
- One graft stenosis and four graft occlusions were noted for the left ITA grafts.
- The right ITA to left anterior descending artery anastomosis patency was high at 95% (38 out of 40 patients).
Conclusions:
- Left ITA grafts are a suitable conduit for revascularizing the circumflex coronary artery.
- Bilateral ITA grafting offers excellent long-term patency and acceptable mortality, especially recommended for younger patients.
Abstract:
The current trend in coronary artery surgery is to revascularize the left coronary artery branches with bilateral internal thoracic arteries (ITA). For this procedure, the right ITA is usually grafted to the left anterior descending coronary artery while the circumflex coronary artery is revascularized by the left ITA. The mid to long-term results of the left ITA on the circumflex system were examined in this study. Forty of 48 patients operated on between 1996 and 1998 who had undergone revascularization of the left coronary artery with both ITAs and who fulfilled the study criteria underwent control coronary arteriography to determine the mid to long-term patency of LITA grafts on the circumflex artery. The median time for follow-up was 53 months (range, 49 to 70 months). Of the 40 angiographically controlled patients, 35 had patent left ITA to circumflex artery anastomosis (87.5%). One graft stenosis and four graft occlusions were observed. In the same group, right ITA to left anterior descending coronary artery anastomoses were patent in 38 patients (95%). Left ITA grafts seem to be the conduit of choice for revascularization of the circumflex coronary artery. In combination with the in situ right ITA to left anterior descending coronary artery anastomosis, in situ left ITA grafting to the circumflex system can be done with acceptably low mortality and excellent long-term patency rates. Its utilization is particularly advised in young patients where the importance of left coronary artery revascularization by bilateral ITA grafts is increased.