Tadashi Isomura1, Masanori Hirota2, Minoru Yoshida3, Shunsuke Yamagishi3, Kohei Sumi3, Shigehiko Yoshida3. 1. Department of Cardiovascular Surgery, IMS Tokyo Katsushika General Hospital, Tokyo Japan. Electronic address: t-isomura@ims.gr.jp. 2. Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan. 3. Department of Cardiovascular Surgery, IMS Tokyo Katsushika General Hospital, Tokyo Japan.
Abstract
BACKGROUND: The use of the left internal thoracic artery (LITA) is a golden standard in coronary artery bypass grafting (CABG). Multi-arterial grafting for CABG is being increasingly emphasized for CABG. This study aimed to solve the utility of the right ITA (RITA) for multiple CABG as "free" RITA and described new evidence. METHODS: One hundred sixty-three patients received solo CABG with bilateral ITAs between 2005 and 2018. The RITA was used as in situ RITA (Group-A, n=62) and or the composite graft created and saphenous vein graft (SVG) (Group-B, n=101). The patency rate and graft size of the composite 'free' RITA and SVG were examined by coronary computed tomographic angiography (CTA). RESULTS: The average number of distal anastomoses per patient was 3.4±1.0 in Group-A, and 4.2±1.1 in Group-B (P<0.001). The sequential grafting with free RITA was in 86 patients. The patency rate of both LITA and RITA was similar in both groups. In Group-B, 40 patients received late CTA at a mean of 46 months (17-175 months). The late patency rate was 95.1% in LITA, and 96.9% in free RITA. The diameter of free RITA increased from 2.06±0.34 to 2.37±0.23 mm (P=0.036); that of in situ LITA increased from 2.08±0.51 to 2.44±0.49 mm (P=0.047), and that of composite SVG decreased from 4.1± 0.9 to 2.6± 0.7 mm (P<0.001). CONCLUSIONS: Multiple bypass grafting can be sufficiently achieved with LITA and free RITA. The growth potential of free RITA and in situ LITA might be the important role of expected long-term patency.
BACKGROUND: The use of the left internal thoracic artery (LITA) is a golden standard in coronary artery bypass grafting (CABG). Multi-arterial grafting for CABG is being increasingly emphasized for CABG. This study aimed to solve the utility of the right ITA (RITA) for multiple CABG as "free" RITA and described new evidence. METHODS: One hundred sixty-three patients received solo CABG with bilateral ITAs between 2005 and 2018. The RITA was used as in situ RITA (Group-A, n=62) and or the composite graft created and saphenous vein graft (SVG) (Group-B, n=101). The patency rate and graft size of the composite 'free' RITA and SVG were examined by coronary computed tomographic angiography (CTA). RESULTS: The average number of distal anastomoses per patient was 3.4±1.0 in Group-A, and 4.2±1.1 in Group-B (P<0.001). The sequential grafting with free RITA was in 86 patients. The patency rate of both LITA and RITA was similar in both groups. In Group-B, 40 patients received late CTA at a mean of 46 months (17-175 months). The late patency rate was 95.1% in LITA, and 96.9% in free RITA. The diameter of free RITA increased from 2.06±0.34 to 2.37±0.23 mm (P=0.036); that of in situ LITA increased from 2.08±0.51 to 2.44±0.49 mm (P=0.047), and that of composite SVG decreased from 4.1± 0.9 to 2.6± 0.7 mm (P<0.001). CONCLUSIONS: Multiple bypass grafting can be sufficiently achieved with LITA and free RITA. The growth potential of free RITA and in situ LITA might be the important role of expected long-term patency.