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Pedicled versus skeletonized internal thoracic artery grafts: a randomized trial
Mats Dreifaldt1, Ninos Samano2, Håkan Geijer3
1Department of Cardiovascular and Thoracic Surgery, School of Medical Sciences, Örebro University, Örebro, Sweden.
Insights
Skeletonization of the left internal thoracic artery (LITA) is safe and does not compromise graft patency compared to pedicled LITA grafts in coronary artery bypass surgery. Target artery stenosis below 70% is key to graft success.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Surgical Techniques
Background:
- Concerns exist regarding potential graft damage and reduced patency with skeletonized internal thoracic artery (ITA) grafts.
- Comparing pedicled versus skeletonized ITA grafts is crucial for optimizing coronary artery bypass grafting (CABG) outcomes.
Purpose of the Study:
- To compare mid- and long-term patency rates of pedicled versus skeletonized left internal thoracic artery (LITA) grafts.
- To evaluate the impact of LITA graft preparation technique on graft survival in CABG patients.
Main Methods:
- A randomized controlled trial involving 109 patients undergoing CABG.
- Patients received either a pedicled or skeletonized LITA graft to the left anterior descending artery.
- Follow-up included conventional angiography at 3 years and CT angiography at 8 years.
Main Results:
- At 3 years, patency rates were 95.8% for pedicled and 90.4% for skeletonized LITA grafts (p=0.44).
- At 8 years, patency rates were 93.0% for pedicled and 90.2% for skeletonized LITA grafts (p=0.71).
- Graft failure was associated with target coronary artery stenosis <70%.
Conclusions:
- Skeletonization of the LITA is a viable technique that does not compromise graft patency.
- Target artery stenosis severity is a critical determinant of LITA graft patency in CABG.
Objective:
Concerns have been raised regarding whether skeletonization of the internal thoracic artery could damage the graft and thereby reduces its patency. The objective of this study was to compare patency rates at mid- and long-term follow-up between pedicled and skeletonized left internal thoracic artery grafts.
Methods:
This randomized controlled trial included 109 patients undergoing coronary artery bypass surgery. The patients were assigned to receive either one pedicled or one skeletonized left internal thoracic artery graft to the left anterior descending artery. Follow-up was performed at 3 years with conventional angiography, and at 8 years with computed tomography angiography. Differences between patency rates were analyzed with Fisher's exact test and a generalized linear model.
Results:
The patency rates for pedicled and skeletonized left internal thoracic artery grafts were 46/48 (95.8%) versus 47/52 (90.4%), p = 0.44 at 3 years, and 40/43 (93.0%) versus 37/41 (90.2%), p = 0.71 at 8 years, respectively. The difference in patency rates for pedicled and skeletonized grafts was 5.4% (95% confidence interval: -4.2-14.5) at 3 years and 2.8% (95% confidence interval: -9.9-14.1) at 8 years. All failed grafts, except for one with a localized stenosis, were anastomosed to native coronary arteries with a stenosis less than 70%. Three patients suffered sternal wound infections (two in the pedicled group, one in the skeletonized group).
Conclusions:
The skeletonization technique can be used without jeopardizing the patency of the left internal thoracic artery. The most important factor in graft failure was target artery stenosis below 70%.
