Bilateral internal thoracic artery surgery: 17-year experience.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Grafting

Background:

• Internal thoracic artery (ITA) grafts have shown promising early results in coronary artery bypass grafting (CABG).
• Saphenous vein grafts (SVG) are a common alternative but have demonstrated limitations in long-term patency and clinical outcomes.
• Comparative studies are essential to determine the optimal arterial conduit for CABG patients.

Purpose of the Study:

• To compare the late angiographic morphology and long-term clinical outcomes of ITA grafts versus SVG in the same patients undergoing CABG.
• To evaluate the specific benefits of bilateral ITA grafting in patients requiring multiple arterial conduits.
• To establish the superiority of ITA grafts in improving survival, reducing angina recurrence, myocardial infarction, and reoperation rates.

Main Methods:

• Angiographic assessment of ITA and SVG morphology at late follow-up.
• 15-year clinical follow-up of 748 consecutive CABG patients (532 with ITA and SVG, 216 with SVG alone).
• Analysis of cumulative survival, angina recurrence, myocardial infarction, and reoperation rates.

Main Results:

• ITA grafts exhibited superior late morphology compared to SVG.
• Patients receiving ITA grafts showed significantly higher cumulative survival rates (P < 0.01).
• ITA grafts were associated with less early angina recurrence (P < 0.01), fewer late myocardial infarctions (P < 0.02), and lower reoperation rates (P < 0.001).
• Bilateral ITA grafts (n=38) demonstrated exceptional outcomes: 0% operative mortality, 89.0% 10-year survival, and minimal annual rates for angina recurrence (1.5%), myocardial infarction (1.1%), and reoperation (0%).

Conclusions:

• Internal thoracic artery grafts are morphologically and clinically superior to saphenous vein grafts for coronary artery bypass surgery.
• Routine use of bilateral ITA grafts is recommended for patients needing multiple bypasses due to superior long-term benefits.
• Careful attention to surgical technique is crucial to avoid potential pitfalls and maximize the benefits of ITA grafting.