V-composite grafting using the right internal thoracic artery grafts anastomosed to aorto-coronary bypass grafts

Composite grafting using the right internal thoracic artery (RITA) is occasionally performed when the in situ RITA does not have sufficient length to reach the target vessel. In this study, we assessed the clinical and angiographic outcomes of coronary artery bypass grafting (CABG) with V-composite grafting (defined as a distance between the proximal anastomosis of the RITA and the ascending aorta of ≤1 cm) using the RITA anastomosed to aortocoronary (A-C) bypass grafts.

Between September 2004 and December 2012, 177 patients underwent CABG with V-composite grafting using the RITA and the A-C bypass graft [radial artery (RA) or saphenous vein graft (SVG)] at our institution. The mean age was 69.2 ± 8.5 years and 149 (84.2%) were men. The clinical outcomes and patency rates of distal anastomoses of the composite RITA were retrospectively evaluated.

Mean distal anastomoses per patient were 4.6 ± 1.0, and mean distal anastomoses of the RITA per patient were 1.3 ± 0.5. Inflow conduit of the RITA was the RA in 16 (9.0%) patients and an SVG in 161 (91.0%) patients. The 30-day mortality rate was 1.1% (2/177). The overall patency rate of distal anastomoses of the composite RITA on early (before discharge) and follow-up (at 1 year) angiography was 97.6 and 93.6%, respectively. The inflow conduit (RA or SVG), stenosis grade of target vessel and sequential grafting did not affect the patency rate of the composite RITA.

V-composite grafting using the RITA and the A-C bypass graft provides excellent clinical outcomes with satisfactory early and 1-year patency rates.