Patency of Internal Thoracic Artery Compared to Vein Grafts - Postoperative Angiographic Findings in 1189 Symptomatic Patients in 12 Years

Abstract

Background: The evidence respecting the superior patency of ITA-grafts compared to SVG is conclusive. This study evaluates the angiographic findings in 1189 symptomatic patients who received either one or both ITA-grafts with or without additional SVG. Methods: 1189 patients (975 males, aged 62.4 ± 9.1 years), operated between 2/93 and 7/05, underwent angiography due to reappearance of angina. Data were compared for patency of single ITA (n = 618), bilateral ITA (n = 416) or SVG (n = 2218). Re-catherization was performed after 3.8 ± 2.7 years. Severe bypass stenosis or graft occlusion was related to the target vessels. Results: 3668 bypasses were performed in 1189 patients. The occlusion rate was 16.5 % for SVG and 7.0 % for all ITAs (p < 0.001). Severe stenosis was detected in 4.8 % of SVG and in 3.7 % of ITAs (p < 0.05). Patency was 89.6 % for LITA, 88.7 % for RITA, and 78.7 % for SVG. The occlusion rate for LITA was: to LAD 6.6 %, DIA 8.5 %, obtuse marginal branch/CX 11.5 %. The occlusion rate for RITA was: to LAD 4.6 %, RCA 9.1 %., diag. branch 7.1 %. The occlusion rate for vein grafts was: to LAD 17.3 %, DIA 14.4 %, obtuse marginal branch/CX 15.9 %, to RCA 17.0 %. Patency for all ITAs was 89.3 % vs.78.7 % for all SVG (p < 0.05). Despite symptoms, bypass patency was found in 711 patients (59.8 %). Conclusion: The superior patency of ITA-grafts could be documented angiographically in a negatively selected, symptomatic population. Graft occlusion was at least twofold higher for SVG.

coronary bypass surgery - cardiovascular surgery - ITA versus vein grafts - angiographic findings

References

• 1 Lytle B W, Cosgrove D M. Coronary artery bypass surgery.  Curr Probl Surg. 1992;  29 737-807
• 2 Chow M ST, Sim E, Orszulak T A, Schaft H V. Patency of internal thoracic artery grafts: comparison of right vs. left and importance of vessel grafted.  Circulation. 1994;  90 129-132
• 3 Schmidt S E, Kones J W, Thornby Jl, Miller C C, Beali A C. Improved survival with multiple left sided bilateral internal thoracic artery grafts.  Ann Thorac Surg. 1997;  64 9-15
• 4 Pick A W, Orszulak T A, Anderson P J, Schaft H V. Single versus bilateral internal mammary artery grafts: 10 year outcome analysis.  Ann Thorac Surg. 1997;  64 599-605
• 5 Lytle B W, Blackstone E H, Loop F D. et al . Two internal thoracic artery grafts are better than one.  J Thorac Cardiovasc Surg. 1999;  117 855-872
• 6 Gansera B, Günzinger R, Angelis I, Eichinger W, Neumaier-Prauser P, Kemkes B M. End of the millennium - end of the single thoracic artery graft. Two thoracic arteries - standard for the next millennium? Early clinical results and analysis of risk factors in 1487 patients with bilateral internal thoracic artery grafts.  Thorac Cardiovasc Surg. 2001;  49 10-15
• 7 Fiore A C, Naunheim K S, Dean P. et al . Results of internal thoracic artery grafting over 15 years: single versus double grafts.  Ann Thorac Surg. 1990;  49 202-209
• 8 Berreklouw E, Schonberger J P, Ercan H. et al . Does it make sense to use two internal thoracic arteries?.  Ann Thorac Surg. 1995;  59 1456-1463
• 9 Endo M, Nishida H, Tomizawa Y, Kasanuki H. Benefit of bilateral internal mammary artery grafts over single IMA graft for multiple coronary artery bypass grafting.  Circulation. 2001;  104 2164-2170
• 10 Galbut D L, Traad E A, Dorman M J. et al . Seventeen-year experience with bilateral internal mammary artery grafts.  Ann Thorac Surg. 1990;  49 195-201
• 11 Dietl C A, Benoit C H, Gilbert C L. et al . Which is the graft of choice for the right coronary and posterior descending arteries? Comparison of the right internal mammary artery and the right gastroepiploic artery.  Circulation. 1995;  92 (Suppl II) 92-97
• 12 Dion R, Glineur D, Derouck D. et al . Long-term clinical and angiographic follow up of sequential internal thoracic artery grafting.  Eur J Cardiothorac Surg. 2000;  17 407-414
• 13 Calafiore A, Di Giammarco G, Luciani N, Maddestra N, Di Nardo E, Angelini R. Composite arterial conduits for a wider arterial myocardial revascularization.  Ann Thorac Surg. 1994;  58 185-190
• 14 Buxton B F, Ruenasakulrach P, Fuller J, Rosalion A, Reid C M, Tatoulis J. The right internal thoracic artery graft - benefits of grafting the left coronary system and native vessels with a high grade stenosis.  Eur J Cardiothorac Surg. 2000;  18 255-261
• 15 Tatoulis J, Buxton B F, Fuller J A. Results of 1454 free right internal thoracic artery-to-coronary artery grafts.  Ann Thorac Surg. 1997;  64 1263-1268
• 16 Al-Ruzzeh S, George S, Bustoni M, Nakamura K, Ilsley C, Amrani M. Early clinical and angiographic outcome of the pedicled right internal thoracic artery graft to the left anterior descending artery.  Ann Thorac Surg. 2002;  73 1431-1435
• 17 Sakata R, Ura M, Nakayama Y, Arai Y. In situ right internal thoracic artery graft for revascularization of circumflex artery. Early results and long-term angiographic follow up.  Jpn J Thorac Cardiovasc Surg. 1999;  47 273-276
• 18 Ura M, Sakata R, Nakayama Y, Arai Y, Saito T. Long-term patency rate of right internal thoracic artery bypass via the transverse sinus.  Circulation. 1998;  98 2043-2048
• 19 Lev-Ran O, Pevni D, Maza M, Paz Y, Kramer A, Mohr R. Arterial myocardial revascularization with in-situ-crossover right internal thoracic artery to left anterior descending artery.  Ann Thorac Surg. 2001;  72 798-803
• 20 Kawata T, Taniguchi S, Nishioka H. et al . Benefits according to grafting of the right internal thoracic artery to the left anterior descending artery in coronary artery bypass grafting.  Jpn J Thorac Cardiovasc Surg. 1999;  47 388-393
• 21 Tatoulis J, Buxton B F, Fuller J A. Patencies of 2127 arterial to coronary conduits over 15 years.  Ann Thorac Surg. 2004;  77 93-101
• 22 Calafiore A M, Di Giammarco G, Teodori G. et al . Late results of first myocardial revascularization in multiple vessel disease: single versus bilateral internal mammary artery with or without saphenous vein grafts.  Eur J Cardiothorac Surg. 2004;  26 542-548
• 23 Gansera B, Schmidtler F, Gillrath G. et al . Does bilateral ITA-grafting increase perioperative complications? Outcome of 4462 patients with bilateral vs. 4204 patients with single ITA-bypass.  Eur J Cardiothorac Surg. 2006;  30 318-323
• 24 Gansera B, Loef A, Angelis I, Gillrath G, Schmidtler F, Kemkes B M. Double thoracic artery - halved mid-term mortality? A 5-year follow-up of 716 patients receiving bilateral ITA versus 662 patients with single ITA.  Z Kardiol. 2004;  93 878-883