Sequential in situ left internal thoracic artery grafting to the circumflex and right coronary artery areas
Cihat Bakay1, Burak Onan, Așkin Ali Korkmaz
1Department of Cardiovascular Surgery, Florence Nightingale Hospital, Istanbul, Turkey.
Insights
Sequential in situ left internal thoracic artery (ITA) grafting to the circumflex and right coronary artery (RCA) areas provides excellent graft patency and good midterm outcomes for patients with 3-vessel coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Bilateral internal thoracic artery (ITA) grafting is explored to improve 3-vessel coronary artery revascularization.
- This study evaluates sequential in situ left ITA grafting to circumflex and right coronary artery (RCA) territories.
Purpose of the Study:
- To assess the midterm outcomes of sequential in situ left ITA grafting for 3-vessel coronary artery disease.
- To determine graft patency rates and clinical results in a selected patient cohort.
Main Methods:
- 102 patients with 3-vessel coronary artery disease underwent bilateral in situ ITA arterial myocardial revascularization.
- Left ITA was used for sequential grafting to circumflex and distal RCA branches; right ITA grafted the left anterior descending artery area.
- Follow-up included clinical monitoring and postoperative coronary imaging.
Main Results:
- Overall bilateral ITA graft patency was 97.1% (FitzGibbon grade A+B).
- Sequential left ITA anastomoses to circumflex and RCA territories showed 96.7% patency.
- Excellent patency rates were observed for all ITA graft segments, with low rates of angina recurrence (0.9%) and no cardiac deaths.
Conclusions:
- Sequential in situ left ITA grafting to the circumflex and RCA areas offers acceptable midterm results.
- This technique is a viable option for selected patients with 3-vessel coronary artery disease requiring comprehensive arterial revascularization.
Background:
Several bilateral internal thoracic artery (ITA) grafting patterns have been proposed to enhance 3-vessel coronary artery revascularization. We present the outcomes of sequential in situ left ITA grafting to the circumflex and right coronary artery (RCA) areas.
Methods:
Between January 2001 and September 2007, 102 patients with 3-vessel coronary artery disease underwent arterial myocardial revascularization with bilateral in situ ITA grafts. The circumflex and distal RCA branches were revascularized sequentially with the left ITA. The left anterior descending artery area was grafted with the right ITA.
Results:
Ninety-nine patients (97.0%) were monitored for 37.2 ± 2.9 months, and 77 (75.4%) underwent postoperative coronary imaging after 27.8 ± 5.8 months. The bilateral ITA grafts were 97.1% patent (FitzGibbon grade A+B) overall. The sequential anastomoses of the left ITA to the circumflex and RCA territories were 96.7% patent overall, with competitive flow (FitzGibbon grade B) in 3 patients. The patency rates of sequential anastomoses to the circumflex and RCA branches were 98.0% and 95.0%, respectively. The right posterolateral and right descending posterior artery anastomoses were 91.8% and 100% patent, respectively. The in situ right ITA grafts to the left anterior descending artery area were 98.0% (FitzGibbon grade A+B) patent overall. Angina recurred in 1 patient (0.9%) 6 months after the operation. Percutaneous coronary interventions were performed in 3 patients (3.8%). No cardiac deaths occurred during the follow-up period.
Conclusions:
Sequential in situ left ITA grafting to the circumflex and RCA areas yields acceptable midterm results in selected patients with 3-vessel disease.
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