Off-pump bilateral internal thoracic artery grafting in patients with left main disease
Toshihiro Fukui1, Minoru Tabata, Susumu Manabe
1Department of Cardiovascular Surgery, Sakakibara Heart Institute, Fuchu City, Tokyo, Japan. tfukui-cvs@umin.ac.jp
Insights
Off-pump bilateral internal thoracic artery grafting is safe and effective for patients with left main coronary artery disease. Graft patency rates were comparable to those without left main disease, demonstrating excellent long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Left main coronary artery disease poses significant risks.
- Off-pump coronary artery bypass grafting (CABG) offers potential benefits.
- Bilateral internal thoracic artery (BITA) grafting is a complex surgical strategy.
Purpose of the Study:
- To evaluate the safety and efficacy of off-pump BITA grafting.
- To compare outcomes in patients with and without left main disease.
- To assess early and 1-year graft patency rates.
Main Methods:
- Retrospective review of 768 patients undergoing off-pump BITA grafting (2004-2009).
- Comparison of perioperative outcomes and complications between patients with and without left main disease.
- Angiographic assessment of graft patency at 1-year follow-up.
Main Results:
- No significant difference in perioperative mortality or complications between groups.
- Left internal thoracic artery (LITA) used for LAD in 87.4% (no LM) vs. 70.5% (LM disease).
- Right internal thoracic artery (RITA) used for LAD in 12.2% (no LM) vs. 29.1% (LM disease).
- 1-year patency rates: LITA 97.0% (LM) vs. 97.6% (no LM); RITA 93.2% (LM) vs. 91.6% (no LM).
- No significant difference in patency rates between groups for either LITA or RITA.
Conclusions:
- Off-pump BITA grafting is a safe and effective revascularization strategy for left main coronary artery disease.
- Graft patency outcomes for BITA in left main disease are comparable to those without left main disease.
- BITA grafting demonstrates excellent long-term patency in complex coronary artery disease.
Objective:
This study assessed the safety and efficacy of off-pump bilateral internal thoracic artery grafting in patients with left main disease.
Methods:
We reviewed the records of 768 patients who underwent off-pump bilateral internal thoracic artery grafting between September 2004 and June 2009. Bilateral internal thoracic artery grafts were used for the left coronary system in all patients, of whom 268 had left main disease and 500 did not. We compared operative and postoperative variables and early and 1-year angiographic patency rates of the bilateral internal thoracic artery between the 2 groups.
Results:
The perioperative mortality and incidence of postoperative complications were not significantly different between groups. In patients without left main disease, the left and right internal thoracic arteries were used for the left anterior descending artery in 87.4% and 12.2% of patients, respectively. In patients with left main disease, the left and right internal thoracic arteries were used for the left anterior descending artery in 70.5% and 29.1% of patients, respectively. In patients with left main disease, the patency rates for the left and right internal thoracic arteries at 1-year postoperative follow-up were 97.0% and 93.2%, respectively. In patients without left main disease, the patency rates for the left and right internal thoracic arteries at 1-year follow-up were 97.6% and 91.6%, respectively. The patency rates of the left and right internal thoracic arteries did not differ significantly in patients with or without left main disease (P = .9803 and P = .7205 in left and right internal thoracic arteries, respectively).
Conclusions:
Off-pump bilateral internal thoracic artery grafting was safe and effective in patients with left main disease. The patency rates of both grafts were comparable to those of patients without left main disease.
