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Ann Thorac Surg 2005;79:564-569
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Revascularization of the Right Coronary Artery in Bilateral Internal Thoracic Artery Grafting

Dmitry Pevni, MDa,b,*, Gideon Uretzky, MDa,b, Paz Yosef, MDa,b, Ben Gal Yanay, MDb, Itzhak Shapira, MDb, Nahum Nesher, MDb, Ron Braunshtein, MDb, Rephael Mohr, MDb

a Department of Thoracic and Cardiovascular Surgery, Tel-Aviv Sourasky, Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
b Department of Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Accepted for publication July 6, 2004.

* Address reprint requests to Dr Pevni, Department of Thoracic and Cardiovascular Surgery, Tel-Aviv Sourasky Medical Center, 6 Weizman St, 64239 Tel-Aviv, Israel (E-mail: pevnid{at}yahoo.com).

BACKGROUND: Bilateral internal thoracic artery (BITA) grafting with a composite T-graft enables right coronary artery (RCA) system revascularization with the distal end of the free right internal thoracic artery (RITA). This study compares this grafting technique to left-sided BITA grafting and RCA revascularization with the right gastroepiploic artery (RGEA) and saphenous vein grafts (SVG).

METHODS: From April 1996 to July 1999, 1000 consecutive patients underwent left-sided revascularization with BITA. In 231 patients RCA grafting was performed with free RITA, in 246 with RGEA, in 142 with SVG, and 381 did not receive any graft to the RCA (no-graft group).

RESULTS: Female gender, old age (> 70), emergency, and congestive heart failure were less prevalent in the RGEA group, and prior percutaneous transluminal coronary angioplasty was more prevalent in the no-graft group. Thirty-day mortality (3.6%, 4.9%, 2%, and 3.4% in the RITA, SVG, RGEA, and no-graft groups, respectively) and occurrence of perioperative complications (sternal infection, myocardial infarction, cerebrovascular accident, and bleeding) were similar. Overall, however, the trend was toward a higher complication rate in the RITA group (10.3%, 4.9%, 5.6%, and 7.3% respectively, p = 0.06). Midterm follow-up (40 to 78 months) showed similar 6-year survival (Kaplan-Meier) (88%, 87%, 89.5%, and 85.5%, respectively) and similar return of angina (10.8%, 6.3%, 10.6%, and 9.5%, respectively) in the four groups.

CONCLUSIONS: Early and midterm results in patients undergoing left-sided BITA grafting are not affected by the conduit used for RCA grafting.




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