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Thoracic Aorta

Thoracic Aorta

The thoracic section of the aorta begins at the T5 vertebra and extends to the T12 level at the diaphragm, initially progressing through the mediastinum to the left of the spinal column. Throughout its course in the thoracic segment, the thoracic aorta emits various offshoots known collectively as visceral and parietal branches. The branches that predominantly supply blood to visceral organs are termed visceral branches and include bronchial, pericardial, esophageal, and mediastinal arteries,...

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Novel and Innovative Hybrid Technique for Type A Aortic Dissection

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Sequential internal thoracic artery bypass is safe but does not improve survival.

Keven Gagné¹, Alain Deschamps², Raymond Cartier¹

¹Department of Cardiovascular Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.

The Annals of Thoracic Surgery

|May 20, 2014

Summary

Bilateral internal thoracic artery (ITA) grafting improves survival in coronary artery surgery. Adding sequential ITA bypass grafting is safe but offers no significant survival benefit in off-pump procedures.

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Area of Science:

Cardiovascular Surgery
Thoracic Surgery
Vascular Surgery

Background:

The established benefit of internal thoracic artery (ITA) sequential bypass grafting to single or bilateral ITA grafts for enhanced arterial revascularization remains unclear.
Coronary artery bypass grafting (CABG) is a common surgical procedure for treating coronary artery disease.

Purpose of the Study:

To evaluate the safety and efficacy of ITA sequential bypass grafting in coronary artery surgery.
To compare outcomes between single and bilateral ITA grafting strategies, with and without sequential bypass.

Main Methods:

Retrospective review of 1,400 patients undergoing off-pump CABG for multivessel disease.
Patients were categorized into four groups: single ITA alone, single ITA with sequential, bilateral ITA alone, and bilateral ITA with sequential.
Analysis included assessment of complete revascularization, perioperative outcomes, and long-term survival.

Main Results:

Bilateral ITA grafting was associated with improved overall survival and reduced major adverse cardiac events (MACE) compared to single ITA grafting.
No significant difference in complete revascularization, perioperative mortality, or myocardial infarction rates was observed across groups.
Adding sequential ITA bypass grafting did not significantly improve survival or MACE-free survival in either single or bilateral ITA configurations.

Conclusions:

Bilateral ITA grafting demonstrates superior long-term survival benefits in patients undergoing off-pump CABG for multivessel disease.
While safe, the addition of sequential ITA bypass grafting does not confer additional survival advantages.
These findings support the use of bilateral ITA grafting for improved patient outcomes in specific CABG scenarios.