Results of 1,454 Free Right Internal Thoracic Artery-to-Coronary Artery Grafts☆,☆☆
Section snippets
Patients
From January 1986 to December 1995, 1,454 patients who had a planned free right internal thoracic artery (FRITA) to coronary artery bypass graft as part of their myocardial revascularization were studied. All the data were entered prospectively in a computer database at the time of operation, at discharge, and on routine follow-up.
In 1,443 patients (99%) the FRITA was part of a bilateral ITA procedure. In only 11 instances was the FRITA used without an additional LITA, particularly when only
Operative Mortality
Thirteen patients died perioperatively or within the first 30 days or of complications associated with the operation. The perioperative and 30-day mortality was 0.9%.
Perioperative Morbidity
Fourteen patients (1%) experienced a stroke, defined as any clinically detectable neurologic abnormality producing a motor, speech, or sensory deficit. Twenty-three patients (1.6%) required reoperation for excessive bleeding postoperatively. There was no instance in which the bleeding came from the proximal or distal ITA stumps.
Comment
The excellent long-term patency and freedom from atheroma of ITA grafts has been well documented [6,7]. The expanded use of ITA grafting with the wider use of the RITA graft is a logical development. Though the RITA graft as an attached pedicled graft could reach the proximal circumflex marginal system through the transverse sinus, the anterior descending by passing anterior to the aorta, and the RCA at the acute margin [8,9], we found this approach frequently limiting. With regard to grafting
Discussion
DR HENDRICK B. BARNER (St. Louis, MO): This report from Down Under is on top both quantitatively and qualitatively with a very low mortality and complication rate and excellent 5-year survival. Doctor Tatoulis and his associates have established themselves as leaders in the use of arterial conduits with this presentation. Although from the show-me state, I did not need to be shown that the right ITA is as good as the left or that it should be used as a free conduit. My colleagues and I use it
Announcement
The Society of Thoracic Surgeons is pleased to announce the receipt of an educational grant from Medtronic, Inc, to be used for the development of the Residents Section of the Cardiothoracic Surgeons Network (CTSNet) on the World Wide Web. The site will contain material of interest and use to cardiothoracic residents-in-training throughout the world. It will be maintained and enriched by the residents themselves, with John R. Liddicoat, MD, and John R. Doty, MD, both of Johns Hopkins Hospital,
References (19)
- et al.
Coronary arterial bypass grafts
Ann Thorac Surg
(1968) - et al.
Atherosclerosis of the internal mammary artery
Ann Thorac Surg
(1976) - et al.
Clinical and angiographic assessment of complex mammary artery bypass grafting
J Thorac Cardiovasc Surg
(1986) Contractility of the human internal mammary artery at the distal section increases toward the end. Emphasis on not using the end of the IMA for grafting
J Thorac Cardiovasc Surg
(1993)- et al.
Histologic comparison of experimental coronary artery bypass grafts. Similarity of insitu and free internal mammary artery grafts
J Thorac Cardiovasc Surg
(1988) - et al.
Risk factors for operative mortality and sternal wound infection in bilateral internal mammary artery grafting
J Thorac Cardiovasc Surg
(1994) - et al.
Risks of bilateral internal mammary artery bypass grafting
Ann Thorac Surg
(1990) - et al.
Twelve year experience with internal mammary artery for coronary artery bypass
J Thorac Cardiovasc Surg
(1985) - et al.
The “occluded” internal mammary artery graft: restoration of patency after apparent occlusion associated with progression of coronary disease
J Thorac Cardiovasc Surg
(1983)
Cited by (74)
Surgical salvage of left internal mammary artery graft ostial stenosis
2022, JTCVS TechniquesManagement of Coronary Artery Disease
2022, Surgical Clinics of North AmericaLong-term outcome of the in situ versus free internal thoracic artery as the second arterial graft
2021, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :In our study, the negative impact of using the second ITA as a free compared with an in situ graft on long-term survival could be explained by many potential reasons. First, the extended length of follow-up of our study is one of the longest that is reported with a 25.8-year maximum and an approximately 12-year median follow-up, which was not the case of many other studies11,19-21 in which follow-up is limited to 5 to 10 years. Longitudinal outcome differences that relate to the patency of arterial grafts are not expected to occur early but generally become manifest beyond 10 years of follow-up.
Surgical strategies for bilateral internal mammary artery grafting
2015, International Journal of SurgeryFree arterial graft with domino patch for coronary revascularization
2011, Annals of Thoracic Surgery
- ☆
Presented at the Thirty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Feb 3–5, 1997.
- ☆☆
This article has been selected for the open discussion forum on the STS Web site: http://www.sts.org/annals.