Is the mid-term outcome of free right internal thoracic artery with a proximal anastomosis modification inferior to in situ right internal thoracic artery?

Tomo Yoshizumi, Toshiaki Ito, Atsuo Maekawa, Masatoshi Sunada, Kenii Wakai, Akihiko Usui, Yuichi Ueda

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3 Citations (Scopus)

Abstract

Background: We investigated the mid-term results of free right internal thoracic artery (RITA) grafts used in an aortocoronary fashion with a modified proximal anastomosis. Methods: The subjects were 214 patients who underwent coronary artery bypass grafting with anastomosis to the left circumflex arteries using the RITA as a free graft (Group A: 158 patients) or an in situ graft (Group B: 56 patients). In Group A, the proximal end of the free RITA was anastomosed onto the ascending aorta interposing free graft tissue or to part of its own tissue as a cuff. Results: The number of RITA anastomoses was 1.38 ± 0.50 in Group A and 1.04 ± 0.19 in Group B (P < 0.001). The relationship between perioperative variables and mid-term outcomes was assessed using Cox proportional hazard models. Survival was not associated with the way the RITA graft was performed (Hazard Ratio 5.26, 95 % CI 0.52-53.1, P = 0.159), however, the number of cardiac events was decreased in Group A (Hazard Ratio 2.55, 95 % CI 1.03-6.33, P = 0.043). The graft patency was evaluated in 187 of 214 patients, and at 1, 3 and 5 years was 97.0, 97.0 and 97.0 % in Group A, and 97.9, 92.5 and 80.5 % in Group B (P - 0.378), respectively. Conclusion: By modifying the proximal anastomosis of the free RITA, cardiac events may be decreased, while survival and graft patency comparable with in situ RITA can be obtained, and a significantly larger number of targets can be revascularized.

Original languageEnglish
Pages (from-to)480-488
Number of pages9
JournalGeneral Thoracic and Cardiovascular Surgery
Volume60
Issue number8
DOIs
Publication statusPublished - 01-08-2012

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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