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Frederic S. Joyce
Patrick M. McCarthy
Paul C. Taylor
Delos M. Cosgrove, III
Bruce W. Lytle
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Ann Thorac Surg 1994;58:80-85
© 1994 The Society of Thoracic Surgeons

Articles

Cardiac reoperation in patients with bilateral internal thoracic artery grafts

Frederic S. Joyce, MD, Patrick M. McCarthy, MD, Paul C. Taylor, MD, Delos M. Cosgrove, III, MD, Bruce W. Lytle, MD*

Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio USA

* Address reprint requests to Dr Lytle, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F-25, Cleveland, OH 44195.

The superior long-term paterey of the left internal thoracic artery (ITA) graft is reflected in the enhanced survival of the patients who undergo the procedure, and its use has been shown to lead to a reduced need for reoperation. Evidence is accumulating that use of both ITAs at the primary operation further decreases the need for reoperation, and it is hoped that the use of other arterial conduits will augment this trend. Therefore, the popularity of bilateral ITAs and other arterial conduits in coronary artery operations is growing. However, many surgeons defer using both ITAs at the primary operation partly out of fear of the difficulties that may arise in conjunction with a possible future reoperation. Thirtysix patients underwent reoperation at The Cleveland Clinic Foundation 2 days to 13 years after an earlier bilateral ITA operation because of the progression of native disease, failure of the ITA or vein grafts, or the development of valve disease or end-stage ischemic heart disease. There were four early deaths (11%) and two late deaths, with an average follow-up of 4.3 years (range, 0 to 9.8 years). Forty-seven ITAs were patent preoperatively and 11 crossed the nidline. Eleven were patent but stenosed and in need of revision or replacement. Two were damaged during reoperation; both were repaired, but one was ultimately replaced. Although the mortality associated with this procedure is relatively high and these operations are difficult, reoperation can be performed at an acceptable risk, and substantial surgical objectives can be achieved with good long-term results. "Saving" an ITA at the primary coronary artery operation for use at a possible later reoperation or not using the right ITA to avoid crossing the midline may not be a necessary or optimal strategy.




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