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Ann Thorac Surg 2002;74:S1371-S1376
© 2002 The Society of Thoracic Surgeons

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Supplement: Cardiothoracic Techniques and Technologies

Bilateral skeletonized internal thoracic artery graftings in off-pump coronary artery bypass: early result of Y versus in situ grafts

^a Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
^b Department of Anesthesiology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea

* Address reprint requests to Dr Kim, Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 28 Yeun-Kun Dong, Chong-Ro Ku, Seoul 110-744, South Korea
e-mail: kimkb{at}snu.ac.kr

Presented at the Eighth Annual Cardiothoracic Techniques and Technologies Meeting 2002, Miami Beach, FL, Jan 23–26, 2002.

Background. Use of bilateral skeletonized internal thoracic arteries (ITAs) in off-pump coronary artery bypass (OPCAB) retains several advantages that may eventually result in better patient outcomes. We compared the early results of OPCAB using bilateral ITAs as Y grafts with results of OPCAB using bilateral ITAs as in situ grafts.

Methods. A total of 223 consecutive patients who underwent OPCAB using bilateral skeletonized ITAs as Y grafts (group I, n = 113) or in situ grafts (group II, n = 110) were studied.

Results. Both the number of distal anastomoses per patient and the number of distal anastomoses per bilateral ITA were higher in group I (3.5 ± 1.0 and 2.9 ± 0.7) than in group II (3.0 ± 0.7 and 2.4 ± 0.5) (p < 0.01). Hospital mortality was 1.8% (2/113) in group I and 0.9% (1/110) in group II (p = ns). There were no differences in postoperative complications including atrial fibrillation (13.3% vs 10.9%), perioperative myocardial infarction (0.9% vs 2.7%), mediastinitis (0.9% vs 1.8%), and hypoperfusion syndrome (0.9% vs 0%) between groups I and II (p = ns). Postoperative coronary angiographies performed in 110 patients in group I and 108 patients in group II showed 99.0% (382/386) overall patency and 99.4% (319/321) patency for distal anastomoses using ITAs in group I, and 98.1% (312/318) overall patency and 98.1% (258/263) patency for distal anastomoses using ITA in group II. There were no significant differences in graft patency rates between the two groups (p = ns).

Conclusions. Our results demonstrate that OPCAB using bilateral skeletonized ITAs is technically feasible, with excellent graft patency. Using bilateral skeletonized ITAs as Y grafts increases the number of distal anastomoses that can be performed and does not cause additional postoperative morbidity.

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