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[The assessment of multiple coronary artery bypass with bilateral internal thoracic artery grafts]
1Department of Cardiovascular Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
Insights
Bilateral internal thoracic artery (ITA) grafting for coronary artery bypass grafting (CABG) is safe and effective. This technique demonstrates high graft patency rates, offering a superior alternative to saphenous vein grafts for multiple bypass procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Context:
- Coronary artery bypass grafting (CABG) is a common surgical procedure.
- The use of bilateral internal thoracic arteries (ITA) for CABG has been explored.
- Evaluating the safety and efficacy of bilateral ITA grafting is crucial for patient outcomes.
Purpose:
- To assess the outcomes of coronary artery bypass grafting (CABG) using bilateral internal thoracic arteries (ITA).
- To determine the safety, patency rates, and postoperative complications associated with bilateral ITA grafting.
- To compare the efficacy of bilateral ITA grafting with traditional saphenous vein grafting.
Summary:
- A study involving 68 patients undergoing CABG with bilateral ITA from 1982 to 1991 reported no operative deaths.
- Graft patency rates for the right ITA (RITA) and left ITA (LITA) were high at 98.3% and 96.7%, respectively.
- While complications like reexploration for bleeding occurred, routine bilateral ITA grafting was deemed safe with better early patency than saphenous vein grafts.
Impact:
- Bilateral ITA grafting is a safe and effective strategy for multiple CABG procedures.
- High early patency rates suggest improved long-term outcomes for patients receiving bilateral ITA grafts.
- This approach may offer a superior alternative to conventional saphenous vein grafting in CABG surgery.
Abstract:
From 1982 to March 1991, 68 patients underwent coronary artery bypass grafting (CABG) using bilateral internal thoracic arteries (ITA). There were 62 males (91.2%) and 6 females (8.8%) ranging from 33 to 74 years old (mean 58.5 +/- 9.2). Thirty four patients had old myocardial infarction (OMI) and left main trunk disease was seen in 8.5% of the patients. The number of grafts was 2 to 6 per patient with an average of 3.2 +/- 1.0. In bilateral ITA grafting the combinations of RITA to LAD and LITA to LCX were most frequently used. There were no operative deaths except for one death which occurred while at the hospital. The patency rates for the RITA and LITA were 98.3% and 96.7%, respectively. Postoperative complications included reexploration for bleeding and heart tamponade in 9 patients, and low output syndrome in 7 patients. The frequency of blood transfusion decreased with the use of cell saver. Routine bilateral ITA grafting for multiple CABG is considered safe, with the early patency being relatively better than with saphenous vein grafting.