| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2001;72:798-803
© 2001 The Society of Thoracic Surgeons
a Department of Cardiac and Thoracic Surgery, The Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Accepted for publication May 25, 2001.
Address reprint requests to Dr Mohr, Department of Cardiac and Thoracic Surgery, The Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
e-mail: rephmohr{at}tasmc.health.gov.il
Background. The extra length obtained by skeletonizing the internal thoracic arteries (ITAs) enables versatile use of in situ bilateral ITAs for coronary artery bypass grafting, as the longer skeletonized right ITA more easily reaches the anastomotic site on the left anterior descending coronary artery.
Methods. Between April 1996 and November 1999, 365 consecutive patients underwent revascularization with bilateral in situ ITAs (29% of 1,250 grafting procedures performed with both ITAs in our department during this period). The right ITA was routed anterior to the aorta to graft the left anterior descending coronary artery, and the in situ left ITA was used to graft circumflex branches. Right coronary artery branches were grafted with right gastroepiploic artery or saphenous vein graft. The right ITA crossed the midline above the aorta at the most cranial point to avoid damage in case of a repeat sternotomy in the future.
Results. The operative mortality rate was 2.2% (8 patients). Postoperative morbidity included seven strokes (1.9%), eight sternal wound infections (2.2%), and four perioperative myocardial infarctions (1.1%). Follow-up (6 to 49 months) of 97% of hospital survivors showed a return of angina in 3%. Postoperative coronary angiography (22 patients) revealed a 95% patency rate of both ITAs. One-year and 4-year survival rates (Kaplan-Meier) were 95% and 92.4%, respectively. Important predictors of an early unfavorable event were chronic obstructive pulmonary disease, old age (
70 years), emergency operation, and diabetes. Chronic obstructive pulmonary disease was the only independent predictor of sternal wound infection (odds ratio, 15; 95% confidence interval, 2.8 to 80). It also predicted decreased late survival (hazard ratio, 8.3; 95% confidence interval, 3 to 21.5).
Conclusions. With skeletonized dissection of ITAs, the right ITA easily reaches the left anterior descending coronary artery for left-sided arterial revascularization with in situ bilateral ITAs. This procedure is safe, but we recommend avoiding its use in patients with chronic obstructive pulmonary disease.
This article has been cited by other articles:
|
|
 |
|
  G. Gatti, A. Pappalardo, L. Gon, and B. Zingone Protecting the Crossover Right Internal Thoracic Artery Bypass Graft With a Pedicled Thymus Flap Ann. Thorac. Surg., November 1, 2006; 82(5): 1919 - 1921. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Gansera, F. Schmidtler, G. Gillrath, I. Angelis, K. Wenke, J. Weingartner, S. Yonden, and B. M. Kemkes Does bilateral ITA grafting increase perioperative complications? Outcome of 4462 patients with bilateral versus 4204 patients with single ITA bypass. Eur. J. Cardiothorac. Surg., August 1, 2006; 30(2): 318 - 323. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Caputo, P. Narayan, and G. D. Angelini Conventional surgery with aortic cross-clamping MMCTS, March 15, 2006; 2006(0315): 828. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Bonacchi, F Battaglia, E Prifti, M Leacche, N S Nathan, G Sani, and G Popoff Early and late outcome of skeletonised bilateral internal mammary arteries anastomosed to the left coronary system Heart, February 1, 2005; 91(2): 195 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Bonacchi, E. Prifti, F. Battaglia, G. Frati, G. Sani, and G. Popoff In situ retrocaval skeletonized right internal thoracic artery anastomosed to the circumflex system via transverse sinus: Technical aspects and postoperative outcome J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1302 - 1313. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Fabbrocini, K. Fattouch, G. Camporini, G. DeMicheli, C. Bertucci, P. Cioffi, and D. Mercogliano The descending branch of lateral femoral circumflex artery in arterial CABG: early and midterm results Ann. Thorac. Surg., June 1, 2003; 75(6): 1836 - 1841. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Lev-Ran, R. Mohr, G. Uretzky, D. Pevni, C. Locker, Y. Paz, and I. Shapira Graft of choice to right coronary system in left-sided bilateral internal thoracic artery grafting Ann. Thorac. Surg., January 1, 2003; 75(1): 88 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. J. Woo and T. J. Gardner Myocardial Revascularization with Cardiopulmonary Bypass Card. Surg. Adult, January 1, 2003; 2(2003): 581 - 607. [Full Text]
|
|
|
|
 |
|
 Y. Paz, O. Lev-Ran, C. Locker, and I. Shapira Right coronary artery revascularization in patients undergoing bilateral internal thoracic artery grafting: comparison of the free internal thoracic artery with saphenous vein grafts Interactive CardioVascular and Thoracic Surgery, December 1, 2002; 1(2): 93 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Lev-Ran, Y. Paz, D. Pevni, A. Kramer, I. Shapira, C. Locker, and R. Mohr Bilateral internal thoracic artery grafting: midterm results of composite versus in situ crossover graft Ann. Thorac. Surg., September 1, 2002; 74(3): 704 - 711. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Al-Ruzzeh, S. George, M. Bustami, K. Nakamura, C. Ilsley, and M. Amrani Early clinical and angiographic outcome of the pedicled right internal thoracic artery graft to the left anterior descending artery Ann. Thorac. Surg., May 1, 2002; 73(5): 1431 - 1435. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
