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Myocardial revascularization using both attached internal thoracic arteries. Mid-term clinical evaluation of 117
S Chocron1, K Alwan, F Clement
1Department of Thoracic and Cardiovascular Surgery, Hôpital Saint-Jacques, Besançon, France.
Insights
Bilateral internal thoracic artery (ITA) grafting in myocardial revascularization is safe and effective. This approach in 117 patients showed a 91% survival rate and 91% symptom-free outcome after 18 months.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Background:
- Arterial grafts are increasingly preferred for myocardial revascularization.
- The right internal thoracic artery (RITA) is a viable option when the left internal thoracic artery (LITA) patency is established.
Purpose of the Study:
- To evaluate the safety and efficacy of using bilateral internal thoracic arteries (ITAs) for myocardial revascularization.
- To present the surgical experience and outcomes of this grafting technique.
Main Methods:
- A retrospective analysis of 159 myocardial revascularizations performed between January and October 1990.
- Bilateral ITA grafting was utilized in 117 cases without exclusion criteria.
- Detailed analysis of graft anastomoses, patient demographics, perioperative events, and follow-up data.
Main Results:
- Six patients (5%) experienced 30-day mortality, and 3.4% had perioperative myocardial infarcts.
- A low incidence of complications was observed: no reoperations for bleeding and 0.9% sternal wound infection.
- At a mean follow-up of 18 months, the survival rate was 91%, with 91% of patients remaining symptom-free.
Conclusions:
- Bilateral internal thoracic artery grafting is a safe and effective strategy for myocardial revascularization.
- This technique offers excellent long-term survival and symptom relief for patients undergoing coronary artery bypass surgery.
Abstract:
The current trend in myocardial revascularization is to use arterial grafts in most, if not all cases. The right internal thoracic artery was a logical choice once the left internal thoracic artery patency on the LAD was known. This study presents our experience of using both attached internal thoracic arteries (ITA). Between January and October 1990, 159 myocardial revascularizations were performed in our department. In 117 cases, bilateral ITA grafting was used with non exclusion criteria. There were 100 male and 17 female patients, with a mean age of 61 +/- 8. The LITA was anastomosed to the LAD in 44 cases, and to the marginal artery in 74. The RITA was anastomosed to the LAD in 68 cases, to the marginal artery in 47 and to the right coronary artery in 2. An average of 3.5 bypasses per patient, including saphenous vein grafts, were performed. Six patients (5%) died within 30 days. Four patients (3.4%) were diagnosed as having periperative myocardial infarcts. There were no reoperations for bleeding. One patient (0.9%) presented a sternal wound infection. Mean follow-up was 18 +/- 7 months. Six patients died during the follow-up and the survival rate was 91%. Ninety-five patients (91%) were symptom-free, 9 patients had a recurrent angina. Postoperative coronary angiography was performed in 11 patients (10%).(ABSTRACT TRUNCATED AT 250 WORDS)