Revascularization of the right coronary artery in bilateral internal thoracic artery grafting
Dmitry Pevni1, Gideon Uretzky, Paz Yosef
1Department of Thoracic and Cardiovascular Surgery, Tel-Aviv Sourasky, Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. pevnid@yahoo.com
Insights
Bilateral internal thoracic artery (BITA) grafting for the right coronary artery (RCA) system showed similar early and midterm outcomes regardless of the graft used. Conduit choice for RCA revascularization did not significantly impact survival or angina recurrence in patients undergoing left-sided BITA grafting.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Grafting
Background:
- Bilateral internal thoracic artery (BITA) composite T-grafting allows right coronary artery (RCA) system revascularization using the right internal thoracic artery (RITA).
- This study compares RITA grafting to other conduits for RCA revascularization in patients undergoing left-sided BITA grafting.
Purpose of the Study:
- To compare the efficacy of different conduits for right coronary artery (RCA) revascularization in patients undergoing left-sided bilateral internal thoracic artery (BITA) grafting.
- To evaluate early and midterm outcomes, including mortality, complications, and angina recurrence, associated with various grafting strategies.
Main Methods:
- A retrospective analysis of 1000 consecutive patients undergoing left-sided BITA grafting from April 1996 to July 1999.
- Patients were grouped based on RCA revascularization: free RITA (n=231), right gastroepiploic artery (RGEA) (n=246), saphenous vein graft (SVG) (n=142), or no graft (n=381).
Main Results:
- Thirty-day mortality and perioperative complications were similar across all groups (RITA, RGEA, SVG, no-graft).
- A trend towards higher complication rates was observed in the RITA group (10.3%) compared to RGEA (5.6%), SVG (4.9%), and no-graft (7.3%) groups (p=0.06).
- Midterm follow-up (6-year survival and angina recurrence) showed no significant differences between the four groups.
Conclusions:
- The choice of conduit for right coronary artery (RCA) grafting does not significantly affect early or midterm outcomes in patients undergoing left-sided bilateral internal thoracic artery (BITA) grafting.
- All evaluated methods for RCA revascularization, including free RITA, RGEA, and SVG, demonstrated comparable long-term efficacy when used in conjunction with left-sided BITA grafting.
Background:
Bilateral internal thoracic artery (BITA) grafting with a composite T-graft enables right coronary artery (RCA) system revascularization with the distal end of the free right internal thoracic artery (RITA). This study compares this grafting technique to left-sided BITA grafting and RCA revascularization with the right gastroepiploic artery (RGEA) and saphenous vein grafts (SVG).
Methods:
From April 1996 to July 1999, 1000 consecutive patients underwent left-sided revascularization with BITA. In 231 patients RCA grafting was performed with free RITA, in 246 with RGEA, in 142 with SVG, and 381 did not receive any graft to the RCA (no-graft group).
Results:
Female gender, old age (> 70), emergency, and congestive heart failure were less prevalent in the RGEA group, and prior percutaneous transluminal coronary angioplasty was more prevalent in the no-graft group. Thirty-day mortality (3.6%, 4.9%, 2%, and 3.4% in the RITA, SVG, RGEA, and no-graft groups, respectively) and occurrence of perioperative complications (sternal infection, myocardial infarction, cerebrovascular accident, and bleeding) were similar. Overall, however, the trend was toward a higher complication rate in the RITA group (10.3%, 4.9%, 5.6%, and 7.3% respectively, p = 0.06). Midterm follow-up (40 to 78 months) showed similar 6-year survival (Kaplan-Meier) (88%, 87%, 89.5%, and 85.5%, respectively) and similar return of angina (10.8%, 6.3%, 10.6%, and 9.5%, respectively) in the four groups.
Conclusions:
Early and midterm results in patients undergoing left-sided BITA grafting are not affected by the conduit used for RCA grafting.
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