All internal thoracic artery composite graft revascularization

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Grafting

Background:

• Coronary artery bypass grafting (CABG) is a standard treatment for triple-vessel disease.
• Internal thoracic artery (ITA) grafts offer superior long-term patency rates compared to saphenous vein grafts.
• Optimizing composite graft design is crucial for maximizing revascularization in complex CABG procedures.

Purpose of the Study:

• To identify the most effective composite graft configuration using the internal thoracic artery (ITA) for triple-vessel revascularization.
• To assess the technical feasibility of this composite grafting strategy.

Main Methods:

• Retrospective analysis of 104 consecutive patients undergoing triple-vessel revascularization.
• Evaluation of a specific composite graft design: in situ left ITA for the LAD, with the right ITA anastomosed to the LITA to supply circumflex and right coronary territories.
• Measurement of intraoperative ITA flow rates and number of distal anastomoses.

Main Results:

• The most efficient composite graft design involved an in situ left ITA and a side-attached right ITA.
• The technical feasibility rate for this composite grafting technique was 80% (83/104 patients).
• The mean number of distal anastomoses was 3.8 per patient, with an average intraoperative LITA flow rate of 91.6 mL/min.

Conclusions:

• The described composite ITA graft design is an efficient strategy for triple-vessel revascularization.
• The technical feasibility rate of 80% suggests this technique is viable, with potential for improvement through increased surgical experience.
• This approach maximizes the use of arterial grafts for comprehensive coronary revascularization.