HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Adrian W. Pick Thomas A. Orszulak Hartzell V. Schaff Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pick, A. W. Articles by Schaff, H. V. Search for Related Content PubMed PubMed Citation Articles by Pick, A. W. Articles by Schaff, H. V.

Ann Thorac Surg 1997;64:599-605
© 1997 The Society of Thoracic Surgeons

---

Original Article: Cardiovascular

Single Versus Bilateral Internal Mammary Artery Grafts: 10-Year Outcome Analysis

Section of Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

	Abstract

Top Footnotes Abstract Introduction Patients and Methods Results Comments Appendix 1. Independent... References

 
Background. The superior long-term patency of the internal mammary artery (IMA) confers important short-term and late survival advantages when grafted to the left anterior descending coronary artery. However, it remains uncertain whether patients derive additional survival benefit when both IMAs are used in coronary revascularization.

Methods. Between June 1983 and May 1986, 160 patients (mean age 60 years) received bilateral IMA grafts for coronary artery bypass procedures, and in 93% of patients, the right IMA was used to bypass the left coronary system. During a similar interval, a group of 161 patients matched for symptomatic status and extent of disease (mean age, 62 years) received a single left IMA and saphenous vein grafts.

Results. The two groups were similar with respect to gender, preoperative angina class, priority status, extent of coronary artery disease, left ventricular function, and number of distal anastomoses. Diabetes was more prevalent in the patient group receiving a single IMA graft (27% versus 17.5%; p = 0.05). Early outcome was similar in the two groups; operative mortality was 0.6% for the patient group receiving single IMA grafts and 0% for those with bilateral IMA grafts. The mean follow-up of 320 hospital survivors was 10 years. Univariate analysis revealed significantly fewer overall deaths in the patients receiving bilateral IMA grafts (n = 30; p = 0.05), and less late cardiac mortality (n = 12; p = 0.016). Ten-year actuarial survival for patients dismissed from the hospital was 76% for those receiving single IMA graft versus 85% for those receiving bilateral IMA grafts. Multivariate analysis revealed diabetes (risk ratio = 1.73), advancing age (risk ratio = 1.08), and lower ejection fraction (risk ratio = 1.01) to be the only significant predictors of late cardiac death. Use of a single IMA graft was not significant (p = 0.138) despite a risk ratio of 1.78. Use of only a single IMA graft correlated with an increased risk of angina recurrence (p < 0.001), late myocardial infarction (p = 0.019), and risk of any cardiac event (p < 0.001).

Conclusions. Independent risk factors for late death were diabetes mellitus, older age, and reduced ejection fraction. Patients receiving bilateral IMA grafts had better long-term survival than those with a single IMA graft, but this was not independent of diabetes. Multivariate analysis, however, did confirm that compared with single arterial grafts, bilateral IMA grafting was an independent predictor of lower rates of angina recurrence, late myocardial infarction, and the composite end point of any cardiac event.

	Introduction

Top Footnotes Abstract Introduction Patients and Methods Results Comments Appendix 1. Independent... References

 
Use of the left internal mammary artery (IMA) to bypass the left anterior descending coronary artery (LAD) has become the standard of care based on reports of superior graft patency [1–3], reduced cardiac events [4–7], and enhanced survival when compared with patients receiving vein grafts alone [8–10]. Anticipating additional advantages with the use of a second arterial graft, many surgical groups have used both IMAs during revascularization, but confirmation of further benefit from a second IMA graft is lacking. Indeed, some centers have reported increased operative mortality [2] as well as higher rates of sternal infection, reoperation for bleeding, and the requirement for prolonged postoperative ventilation [11, 12]. In most series, longer follow-up has not demonstrated additional survival advantage over the use of a single IMA graft [1, 13–16], accounting for the procedure's failure to achieve widespread support.

Before the seminal article by Loop and colleagues [9] confirming the benefit of an IMA graft to the LAD, there was conflicting opinion on clinical benefit of even a single IMA graft. In our early experience, we hypothesized that enhanced patency of only one arterial conduit might not be sufficient to reduce late ischemic events; thus, when arterial grafting was employed, we routinely attempted to use both IMAs to bypass branches of the left coronary system. This practice was standard on two surgical services (H.V.S. and T.A.O.) for a 2-year period beginning in January 1984. The present study analyzes late outcome of these patients compared with subsequent patients having revascularization with one IMA.

	Patients and Methods

Top Footnotes Abstract Introduction Patients and Methods Results Comments Appendix 1. Independent... References

 
Patients
During the 24-month period commencing in January 1984, 320 patients with multivessel disease underwent coronary revascularization with bilateral IMA grafts plus saphenous vein grafts (n = 160) or saphenous vein grafts alone (n = 160). Excluded from the review were patients having operation for single-vessel disease, those having reoperations, patients in whom alternate venous or arterial conduits were used, and patients requiring synchronous procedures or multiple endarterectomies. During an expanded time interval extending to May 1986, a matched group of 161 patients with a single IMA and supplementary vein grafts operated on by the same surgeons were identified. These 481 patients constituted 62% of all isolated coronary bypass procedures undertaken during this 3-year interval. The patient groups receiving single and bilateral IMA grafts form the study cohort for this report, and outcome of patients receiving only saphenous vein grafts is also presented.

Surgical Procedures
Indications for myocardial revascularization were based on standard clinical and angiographic criteria. All operations were undertaken through median sternotomy. Internal mammary arteries were dissected with electrocautery, and small side branches were clipped or cauterized; the artery was harvested with both accompanying veins as well as a generous surrounding pedicle of tissue. Generally, IMAs were prepared with dilute solution of papaverine applied topically, and considerable care was taken not to traumatize the endothelium. Cardiopulmonary bypass was conducted under moderate hypothermia (28° to 32°C) with antegrade crystalloid or blood cardioplegia. Distal anastomoses were performed during a single period of aortic occlusion with a running 7-0 polypropylene suture.

In patients receiving a single arterial graft, the left IMA was directed preferentially to the LAD (91%). In patients receiving bilateral IMA grafts, every effort was made to use the right IMA to bypass a branch of the left coronary system; in these patients, the right IMA was anastomosed to the LAD (45%), obtuse marginal artery (38%), right coronary artery (7%), first diagonal branch of LAD (6%), and intermediate coronary artery (4%).

Techniques and conduit routes for the patients receiving bilateral IMA grafts were: pedicled, anterior to the heart (49%); pedicled, through the transverse sinus (28%); free right IMA graft (14%); composite vein graft (6%); or composite arterial graft (3%).

Postoperative Follow-up
Clinical data were abstracted from patients' hospital records, and follow-up information was collected from the patients' most recent clinical visits, letters from home physicians, patient surveys, and telephone interviews. Cardiac-related events included in the calculation of an event-free survival were angina recurrence, cardiac death, sudden death, myocardial infarction (MI), percutaneous transluminal coronary angioplasty, and repeat coronary revascularization. Angina recurrence was defined as New York Heart Association class II or more. Survival analysis was also performed for all causes of death.

Data Analysis
Discrete variables were compared in the patients receiving single versus bilateral IMA grafts with ² tests. The distributions of continuous variables were compared in the two groups with Wilcoxon rank-sum tests. Survival curves were estimated with the Kaplan-Meier method. The relationships of discrete risk factors to survival were investigated with log-rank tests, and the Cox model was used to evaluate continuous risk factors.

Significant risk factors other than single versus bilateral IMA grafts were evaluated multivariately with Cox models (Appendix 1). Single versus bilateral IMA grafts was then added to the resulting multivariate model to determine if the number of IMA grafts was still significant after adjusting for other important risk factors. This analysis was carried out for seven separate late endpoints: all late deaths, late cardiac death, recurrence of angina, MI, percutaneous transluminal coronary angioplasty, reoperation, and any cardiac event.

In all statistical tests, a p value less than 0.05 was considered to be statistically significant.

	Results

Top Footnotes Abstract Introduction Patients and Methods Results Comments Appendix 1. Independent... References

 
Overall survival analysis for the 481-patient cohort demonstrated a clear survival advantage for both patient groups receiving IMA grafts compared with patients receiving only saphenous vein grafts (Fig 1). Patients receiving single or bilateral IMA grafts were then compared with respect to preoperative variables, risk factors for coronary artery disease, and operative parameters. The two groups were generally similar except that average age of patients receiving bilateral IMA grafts was 2 years less than patients with single IMA grafts (p = 0.05), and diabetes was less prevalent in the patients receiving bilateral IMA grafts compared with patients with only one IMA graft (p = 0.05) (Table 1). Cross-clamp and total bypass time for the bilateral IMA patients were slightly prolonged.

View larger version (15K): [in this window] [in a new window]   Fig 1. . Overall survival for patients revascularized with bilateral internal mammary artery (BIMA), single internal mammary artery (SIMA), and vein grafts.

Late follow-up was obtained in all patients (100%), and the mean interval of follow-up (9.8 ± 2.8 years, maximum 12.9 years) was similar in both groups. There were 50 late deaths among patients receiving a single IMA graft, and 29 of these deaths were related to cardiac causes. Patients receiving bilateral IMA grafts experienced an equivalent noncardiac mortality (18 versus 21) but significantly fewer late cardiac-related deaths (12 versus 29; p = 0.016) (Table 3).

View larger version (19K): [in this window] [in a new window]   Fig 2. . Late cardiac survival for patients receiving single (SIMA) versus bilateral internal mammary artery (BIMA) grafts.

View larger version (17K): [in this window] [in a new window]   Fig 3. . Overall survival for diabetic versus nondiabetic patients.

View larger version (19K): [in this window] [in a new window]   Fig 4. . Cumulative incidence of angina recurrence for patients receiving single (SIMA) versus bilateral internal mammary artery (BIMA) grafts.

View larger version (21K): [in this window] [in a new window]   Fig 5. . Freedom from occurrence of any cardiac event for single (SIMA) versus bilateral internal mammary artery (BIMA) grafts.

Eighty-four patients underwent repeat angiography at a mean of 6.9 years follow-up. A total of 124 IMA grafts were studied, revealing an 84% overall patency rate, better for the left IMA (88%) than for the right IMA (75%). Vein graft patency was 54% for these patients who had catheterization because of return of symptoms.

	Comments

Top Footnotes Abstract Introduction Patients and Methods Results Comments Appendix 1. Independent... References

 
Long-term survival and freedom from cardiac-related events after coronary artery bypass grafting are related to the completeness of revascularization, subsequent progression of native vessel disease, and late attrition of bypass conduits [17, 18]. The relative resistance of the IMA to arteriosclerosis is well known [19], and 10-year patency of 80% to 90% is almost twice that expected with saphenous vein grafts [4, 9]. Internal mammary arteries have other advantages including ideal coronary-to-conduit size match, functioning endothelium [20], and the capacity for flow regulation in response to varying myocardial demand [21].

Although early reports suggested use of the IMA increased operative time and perioperative complications, experience has shown that arterial bypass grafts add little, if any, morbidity or mortality [22, 23]. Studies of single IMA grafting from several centers have also confirmed improved cardiac event-free survival at 10 years compared with revascularization with vein grafts only [24, 25].

The potential survival benefit of using a second IMA for coronary artery bypass grafting has been difficult to establish, and there are reports of increased operative mortality [2, 19] and perioperative morbidity [11] with bilateral IMA grafts; major sternal infection was reported in up to 4% of patients having bilateral IMA grafts, especially in diabetic females or patients with postcardiotomy low output states [12]. These reports also suggested that reoperation for bleeding occurred two to three times more frequently as a consequence of the enlarged endothoracic wound, prolonged operative time, and increased platelet dysfunction after bypass; prolonged postoperative ventilatory support has also been reported in patients receiving two IMA grafts [11, 22, 26]. For these reasons, most surgeons have reserved use of bilateral IMA grafts to younger, nondiabetic male patients, and late studies of outcome of bilateral IMA grafts are thus influenced by this selection bias. In the present study, durations of aortic occlusion and cardiopulmonary bypass were slightly prolonged with use of bilateral IMA grafts, but there were no important differences in perioperative mortality or morbidity comparing the two groups.

Also, investigations of late survival after bilateral IMA grafting are confounded by different strategies in use of the right IMA graft and variable periods of observation. In the study of Fiore and associates [2], who evaluated outcome of 100 patients with bilateral IMA grafts and a matched group receiving a single IMA conduit and additional vein grafts, multivariate analysis at 15 years' follow-up failed to show any survival benefit for bilateral IMA grafts despite significantly improved freedom from MI (75% versus 59%; p = 0.025) and recurrent angina (36% versus 27%; p < 0.025) [13]. However, the second mammary was directed in all patients to the right coronary artery. In the series reported by Sargeant and colleagues [27], the right IMA was directed to the diagonal branch of the LAD. Studies by Galbut and coworkers [1], Morris and associates [14], and Dewer and colleagues [15] each included more than 1,000 patients with bilateral IMA grafts, and no significant difference in late mortality was found compared with groups with single arterial grafts; mean follow-up intervals were 3.3, 4, and 5 years, respectively.

The present study differs from most other investigations of bilateral IMA grafting because of the extended follow-up and our protocol whereby every effort was made to use both arterial grafts for bypass of the left coronary system. Both overall survival and survival from cardiac-related deaths were better in patients having two IMA grafts, but multivariate analysis showed that this difference was the result in large part of the greater prevalence of diabetes in patients having only one IMA graft. Nevertheless, there remained an important trend toward fewer late cardiac deaths among patients having bilateral IMA grafts even with adjustment for the difference in prevalence of diabetes.

Patients receiving bypass grafts with both IMAs also had significantly fewer complications of ischemic heart disease during follow-up compared with those having only one IMA graft. This finding of a reduction in late ischemic events [2, 10, 13, 16, 20] gives further support to the observation that use of both IMAs may decrease late cardiac deaths compared with revascularization with one IMA.

Many techniques have been described for bypassing multiple coronary arteries with IMAs [28]. Length of the right IMA may be limited when the pedicle is left intact; however, as demonstrated in the review, pedicled right IMA grafts can reach proximal branches of the circumflex coronary artery through the transverse sinus. Another option is to disconnect the right IMA graft proximally and anastomose it directly to the aorta or use it as a composite arterial or venous conduit, allowing the second IMA to be directed to any vessel in the left coronary circulation. Comparative long-term patency appears to be slightly less for grafts using the right IMA than for those using the left IMA, but when stratified according to the vessel bypassed, patency rates of the right and left IMA are similar [29]. When used as a free graft, IMA patency is approximately 80% at 10 years [30]. We believe that in order to show additional survival benefits from the use of a second arterial conduit, it must be preferentially directed to the left coronary circulation using one of these methods. In our series, this was achieved in 95% of patients.

Diabetes mellitus, older age, and reduced ejection fraction are known risk factors for mortality in prior series and have been demonstrated to predict reduced survival after primary as well as reoperative coronary surgery [31, 32]. A review of 674 patients undergoing bilateral IMA grafting from Emory demonstrated diabetes and reoperative surgery to be the only significant multivariate correlates of poor long-term survival [33].

Late MI occurred more frequently among patients with diabetes in whom its often silent presentation can cause delay in diagnosis and may well explain the survival disadvantage experienced in the non-coronary artery bypass grafting arm of the BARI trial. In our study, use of only a single IMA graft also correlated with an increased risk of late MI independent of diabetes, constituting our second significant finding in favor of bilateral IMA grafts.

In conclusion, our experience confirms clear advantages for the use of bilateral IMA grafts in coronary revascularization by virtue of reduction in the late risk of MI and recurrent angina. We were unable to demonstrate an overall late survival benefit, but there was an important trend toward improvement in late survival free of cardiac death. It seems reasonable, therefore, to expand use of bilateral IMA grafting, especially when the right IMA can be used to bypass a major branch of the left coronary system. For obese and diabetic patients, the radial artery may be a better choice as a second arterial graft, thus minimizing the risk of sternal infection. Final clarification of the long-term survival benefits for patients receiving more than one arterial graft will need to await the results of larger patient series, after possibly longer follow-up. Meanwhile, patients can be offered bilateral IMA grafts with the expectation of improved freedom from recurrence of angina, late MI, and other late cardiac events.

	Appendix 1. Independent Variables Considered in the Multivariate Analysis

Top Footnotes Abstract Introduction Patients and Methods Results Comments Appendix 1. Independent... References

 
Age Sex Diabetes Smoking Hypercholesterolemia Hypertension Obesity Prior acute myocardial infarction Angina New York Heart Association class III and IV Urgent emergency status Left main >50% Ejection fraction (continuous) Performance of a sequential graft Number of coronary anastomoses Number of coronary grafts Internal mammary artery anastomoses Number of vein anastomoses

	Footnotes

Top Footnotes Abstract Introduction Patients and Methods Results Comments Appendix 1. Independent... References

 
Presented at the Poster Session of the Thirty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Feb 3–5, 1997.

Address reprint requests to Dr Schaff, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 (e-mail: schaff{at}mayo.edu).

	References

Top Footnotes Abstract Introduction Patients and Methods Results Comments Appendix 1. Independent... References

 

1. Galbut DL, Traad EA, Dorman MJ, et al. Seventeen-year experience with bilateral internal mammary artery grafts. Ann Thorac Surg 1990;49:195–201.[Abstract/Free Full Text]
2. Fiore AC, Naunheim KS, Dean P, et al. Results of internal thoracic artery grafting over 15 years: single versus double grafts. Ann Thorac Surg 1990;49:202–9.[Abstract/Free Full Text]
3. Barner HB, Swartz MT, Mudd JG, et al. Late patency of the internal mammary artery as a coronary bypass conduit. Ann Thorac Surg 1982;34:408–12.[Abstract/Free Full Text]
4. Lytle BW, Loop FD, Cosgrove DM, et al. Long-term (5–12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg 1985;89:248–58.[Abstract]
5. Okies JE, Page US, Bigelow JC, et al. The left internal mammary artery: the graft of choice. Circulation 1984;70(Suppl 1):213–21.
6. Cameron A, Kemp HG, Green GE. Bypass surgery with the internal mammary artery graft: 15 year follow-up. Circulation 1986;74(Suppl 3):30–6.
7. Barner HB, Standeven JW, Reese J. Twelve-year experience with internal mammary artery for coronary artery bypass. J Thorac Cardiovasc Surg 1985;90:668–75.[Abstract]
8. Cosgrove DM, Loop FD, Lytle BW, et al. Does mammary artery grafting increase surgical risk? Circulation 1985;72(Suppl 2):170.
9. Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the internal mammary artery graft on 10-year survival and other cardiac events. N Engl J Med 1986;314:1–6.[Medline]
10. Cameron A, Davis KB, Green G, Schaff HV. Coronary bypass surgery with internal-thoracic-artery grafts—effects of survival over a 15-year period. N Engl J Med 1996;334:216–9.[Medline]
11. Barner HB, Standeven JW, Reese J. Twelve-year experience with internal mammary artery for coronary artery bypass. J Thorac Cardiovasc Surg 1985;90:668–75.[Abstract]
12. Kouchoukos NT, Wareing TH, Murphy SF, et al. Risks of bilateral internal mammary artery bypass grafting. Ann Thorac Surg 1990;49:210–9.[Abstract/Free Full Text]
13. Naunheim KS, Barner HB, Fiore AC. Results of internal thoracic artery grafting over 15 years: single versus double grafts [Update]. Ann Thorac Surg 1992;53:716–8.[Free Full Text]
14. Morris JJ, Smith LR, Glower DD, et al. Clinical evaluation of single versus multiple mammary artery bypass. Circulation 1990;82(Suppl 4):214–23.
15. Dewar LRS, Jamieson WRE, Janusz MT, et al. Unilateral versus bilateral internal mammary revascularization: survival and event-free performance. Circulation 1995;92(Suppl 2):8–13.
16. Berreklouw E, Schonberger JPAM, Husamettin E, et al. Does it make sense to use two internal thoracic arteries? Ann Thorac Surg 1995;59:1456–63.[Abstract/Free Full Text]
17. Cosgrove DM, Loop FO, Lytle BW, et al. Predictors of reoperation after myocardial revascularization. J Thorac Cardiovasc Surg 1986;92:811–21.[Abstract]
18. Rosengart TK. Risk analysis of primary versus reoperative coronary artery bypass grafting. Ann Thorac Surg 1993;56:S74–7.[Medline]
19. Barner HB, Kaiser GC, Jellinek M, et al. Aorto-coronary vein graft and internal mammary-coronary anastomosis. Arch Surg 1972;105:908–11.[Abstract/Free Full Text]
20. Pearson PJ, Evora PRB, Schaff HV. Bioassay of EDRF from internal mammary arteries: implications for early and late bypass graft patency. Ann Thorac Surg 1992;54:1078–84.[Abstract/Free Full Text]
21. Singh RN, Beg RA, Kay EB. Physiological adaptability: the secret of success of the internal mammary artery grafts. Ann Thorac Surg 1986;41:247–50.[Abstract/Free Full Text]
22. Cosgrove DM, Lytle BW, Loop FD, et al. Does bilateral internal mammary artery grafting increase surgical risk? J Thorac Cardiovasc Surg 1988;95:850–6.[Abstract]
23. Edwards FH, Clark RE, Schwartz M. Impact of internal mammary artery conduits on operative mortality in coronary revascularization. Ann Thorac Surg 1994;57:27–32.[Abstract/Free Full Text]
24. Lytle BW, Cosgrove DM. Coronary artery bypass surgery. Curr Probl Surg 1992;29:737–807.
25. Berreklouw E, Schonberger JPAM, Bavinck JH, et al. Similar hospital morbidity with the use of one or two internal thoracic arteries. Ann Thorac Surg 1994;57:1564–72.[Abstract/Free Full Text]
26. Lytle BW, Cosgrove DM, Loop FD, et al. Perioperative risk of bilateral internal mammary artery grafting: analysis of 500 cases from 1971 to 1984. Circulation 1986;37(Suppl 3):37–41.
27. Sergeant P, Lesaffre E, Flameng W, et al. Internal mammary artery: methods of use and their effect on survival after coronary artery bypass. Eur J Cardiothorac Surg 1990;4:72–8.[Abstract/Free Full Text]
28. Russo P, Orszulak TA, Schaff HV, et al. Use of internal mammary artery grafts for multiple coronary artery bypasses. Circulation 1986;74(Suppl 3):48–52.
29. Chow MST, Sim E, Orszulak TA, et al. Patency of internal thoracic artery grafts: comparison of right versus left and importance of vessel grafted. Circulation 1994;90(Suppl 2):129–32.
30. Tector AJ, Schmahl TM, Janson B, et al. The internal mammary artery graft. Its longevity after coronary bypass. JAMA 1981;246:2181–3.[Abstract/Free Full Text]
31. Lytle BW, Loop FD, Cosgrove DM, et al. Fifteen hundred coronary reoperations: results and determinants of early and late survival. J Thorac Cardiovasc Surg 1987;93:847–59.[Abstract]
32. He GW, Acuff TE, Ryan WH, et al. Determinants of operative mortality in reoperative coronary artery bypass grafting. J Thorac Cardiovasc Surg 1995;110:971–8.[Abstract/Free Full Text]
33. Accola KD, Jones EL, Craver JM, et al. Bilateral mammary artery grafting: avoidance of complication with extended use. Ann Thorac Surg 1993;56:872–9.[Abstract/Free Full Text]

This article has been cited by other articles:

				T. Kinoshita, T. Asai, T. Suzuki, S. Kuroyanagi, S. Hosoba, and N. Takashima Off-pump Bilateral Skeletonized Internal Thoracic Artery Grafting in Elderly Patients Ann. Thorac. Surg., February 1, 2012; 93(2): 531 - 536. [Abstract] [Full Text] [PDF]

				L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, A. M. Hutter Jr, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 6, 2011; 58(24): e123 - e210. [Full Text] [PDF]

				Writing Committee Members, L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 6, 2011; 124(23): e652 - e735. [Full Text] [PDF]

				S. Maltais, H. V. Schaff, R. C. Daly, R. M. Suri, J. A. Dearani, T. M. Sundt III, M. Enriquez-Sarano, Y. Topilsky, and S. J. Park Mitral regurgitation surgery in patients with ischemic cardiomyopathy and ischemic mitral regurgitation: Factors that influence survival J. Thorac. Cardiovasc. Surg., November 1, 2011; 142(5): 995 - 1001. [Abstract] [Full Text] [PDF]

				T. Kinoshita, T. Asai, T. Suzuki, A. Kambara, and K. Matsubayashi Off-Pump Bilateral Versus Single Skeletonized Internal Thoracic Artery Grafting in High-Risk Patients Circulation, September 13, 2011; 124(11_suppl_1): S130 - S134. [Abstract] [Full Text] [PDF]

				H. Y. Hwang, J. S. Kim, K. R. Cho, and K.-B. Kim Bilateral Internal Thoracic Artery In Situ Versus Y-Composite Graftings: Five-Year Angiographic Patency and Long-Term Clinical Outcomes Ann. Thorac. Surg., August 1, 2011; 92(2): 579 - 586. [Abstract] [Full Text] [PDF]

				J. Tatoulis, B. F. Buxton, and J. A. Fuller The Right Internal Thoracic Artery: The Forgotten Conduit--5,766 Patients and 991 Angiograms Ann. Thorac. Surg., July 1, 2011; 92(1): 9 - 17. [Abstract] [Full Text] [PDF]

				Y. Shimizu, G. Watanabe, S. Tomita, I. Matsumoto, and K. Iino A novel technique for harvesting the internal thoracic artery: linear harvesting technique using an ultrasonic surgical aspirator Interact CardioVasc Thorac Surg, June 1, 2011; 12(6): 998 - 1001. [Abstract] [Full Text] [PDF]

				P. A. Kurlansky, E. A. Traad, M. J. Dorman, D. L. Galbut, M. Zucker, and G. Ebra Location of the Second Internal Mammary Artery Graft Does Not Influence Outcome of Coronary Artery Bypass Grafting Ann. Thorac. Surg., May 1, 2011; 91(5): 1378 - 1384. [Abstract] [Full Text] [PDF]

				T. Kinoshita, T. Asai, O. Nishimura, T. Suzuki, A. Kambara, and K. Matsubayashi Off-Pump Bilateral Versus Single Skeletonized Internal Thoracic Artery Grafting in Patients With Diabetes Ann. Thorac. Surg., October 1, 2010; 90(4): 1173 - 1179. [Abstract] [Full Text] [PDF]

				P. A. Kurlansky, E. A. Traad, M. J. Dorman, D. L. Galbut, M. Zucker, and G. Ebra Thirty-Year Follow-Up Defines Survival Benefit for Second Internal Mammary Artery in Propensity-Matched Groups Ann. Thorac. Surg., July 1, 2010; 90(1): 101 - 108. [Abstract] [Full Text] [PDF]

				H. Takagi, M. Matsui, and T. Umemoto Off-Pump Coronary Artery Bypass May Increase Late Mortality: A Meta-Analysis of Randomized Trials Ann. Thorac. Surg., June 1, 2010; 89(6): 1881 - 1888. [Abstract] [Full Text] [PDF]

				S. G. Raja, M. Navaratnarajah, C. S. Kitchlu, S. George, C. D. Ilsley, and M. Amrani 10-Year Follow-Up of Off-Pump Multivessel Coronary Artery Bypass Grafting Asian Cardiovasc Thorac Ann, June 1, 2010; 18(3): 260 - 265. [Abstract] [Full Text] [PDF]

				T. Kinoshita, T. Asai, Y. Murakami, N. Hiramatsu, T. Suzuki, A. Kambara, and K. Matsubayashi Efficacy of Bilateral Internal Thoracic Artery Grafting in Patients With Chronic Kidney Disease Ann. Thorac. Surg., April 1, 2010; 89(4): 1106 - 1111. [Abstract] [Full Text] [PDF]

				A. S. E. Ramadan, C. Stefanidis, W. N'Gatchou, B. El Oumeiri, J.-L. Jansens, J.-M. De Smet, M. Antoine, and D. De Canniere Five years follow-up after Y-graft arterial revascularization: on pump versus off pump; prospective clinical trial Interact CardioVasc Thorac Surg, March 1, 2010; 10(3): 423 - 427. [Abstract] [Full Text] [PDF]

				G. Nasso, R. Coppola, R. Bonifazi, F. Piancone, G. Bozzetti, and G. Speziale Arterial revascularization in primary coronary artery bypass grafting: Direct comparison of 4 strategies--results of the Stand-in-Y Mammary Study. J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1093 - 1100. [Abstract] [Full Text] [PDF]

				M. Di Mauro, M. Contini, A. L. Iaco, A. Bivona, M. Gagliardi, E. Varone, P. Bosco, and A. M. Calafiore Bilateral internal thoracic artery on the left side: A propensity score-matched study of impact of the third conduit on the right side J. Thorac. Cardiovasc. Surg., April 1, 2009; 137(4): 869 - 874. [Abstract] [Full Text] [PDF]

				A. Zacharias, T. A. Schwann, C. J. Riordan, S. J. Durham, A. S. Shah, and R. H. Habib Late Results of Conventional Versus All-Arterial Revascularization Based on Internal Thoracic and Radial Artery Grafting Ann. Thorac. Surg., January 1, 2009; 87(1): 19 - 26. [Abstract] [Full Text] [PDF]

				D. M. Holzhey, S. Jacobs, M. Mochalski, D. Merk, T. Walther, F. W. Mohr, and V. Falk Minimally Invasive Hybrid Coronary Artery Revascularization Ann. Thorac. Surg., December 1, 2008; 86(6): 1856 - 1860. [Abstract] [Full Text] [PDF]

				B. Marcheix, F. Vanden Eynden, P. Demers, D. Bouchard, and R. Cartier Influence of Diabetes Mellitus on Long-Term Survival in Systematic Off-Pump Coronary Artery Bypass Surgery Ann. Thorac. Surg., October 1, 2008; 86(4): 1181 - 1188. [Abstract] [Full Text] [PDF]

				J. F. Sabik III, A. Stockins, E. R. Nowicki, E. H. Blackstone, P. L. Houghtaling, B. W. Lytle, and F. D. Loop Does Location of the Second Internal Thoracic Artery Graft Influence Outcome of Coronary Artery Bypass Grafting? Circulation, September 30, 2008; 118(14_suppl_1): S210 - S215. [Abstract] [Full Text] [PDF]

				I. A. Chloroyiannis Total Arterial Myocardial Revascularization Angiology, August 1, 2008; 59(2_suppl): 80S - 82S. [Abstract] [PDF]

				S. Mohammadi, F. Dagenais, D. Doyle, P. Mathieu, R. Baillot, E. Charbonneau, J. Perron, and P. Voisine Age cut-off for the loss of benefit from bilateral internal thoracic artery grafting Eur J Cardiothorac Surg, June 1, 2008; 33(6): 977 - 982. [Abstract] [Full Text] [PDF]

				N. J.G.M. Veeger, G. F. Panday, A. A. Voors, J. G. Grandjean, J. van der Meer, and P. W. Boonstra Excellent Long-Term Clinical Outcome After Coronary Artery Bypass Surgery Using Three Pedicled Arterial Grafts in Patients With Three-Vessel Disease Ann. Thorac. Surg., February 1, 2008; 85(2): 508 - 512. [Abstract] [Full Text] [PDF]

				Z. N. Kon, E. N. Brown, R. Tran, A. Joshi, B. Reicher, M. C. Grant, S. Kallam, N. Burris, I. Connerney, D. Zimrin, et al. Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass. J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 367 - 375. [Abstract] [Full Text] [PDF]

				M. Shrestha, N. Khaladj, H. Kamiya, M. Maringka, A. Haverich, and C. Hagl Total Arterial Revascularization and Concomitant Aortic Valve Replacement Asian Cardiovasc Thorac Ann, October 1, 2007; 15(5): 381 - 385. [Abstract] [Full Text] [PDF]

				A. Azmoun, R. Ramadan, N. Al-Attar, C. Kortas, S. Ghostine, C. Caussin, M.-L. Bourachot, B. Lancelin, M. Slama, and R. Nottin Exclusive Internal Thoracic Artery Grafting in Triple-Vessel-Disease Patients: Angiographic Control Ann. Thorac. Surg., June 1, 2007; 83(6): 2098 - 2102. [Abstract] [Full Text] [PDF]

				D. Pevni, I. Hertz, B. Medalion, A. Kramer, Y. Paz, G. Uretzky, and R. Mohr Angiographic evidence for reduced graft patency due to competitive flow in composite arterial T-grafts J. Thorac. Cardiovasc. Surg., May 1, 2007; 133(5): 1220 - 1225. [Abstract] [Full Text] [PDF]

				C. Berroeta, A. Benbara, S. Provenchere, N. Ajzenberg, J. Benessiano, J.-P. Depoix, J.-M. Desmonts, B. Iung, and I. Philip A Comparison of Bilateral with Single Internal Mammary Artery Grafts on Postoperative Mediastinal Drainage and Transfusion Requirement Anesth. Analg., December 1, 2006; 103(6): 1380 - 1385. [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]

				V. Guru, S. E. Fremes, and J. V. Tu How many arterial grafts are enough? A population-based study of midterm outcomes J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1021 - 1028. [Abstract] [Full Text] [PDF]

				S. Srivastava, S. Gadasalli, M. Agusala, R. Kolluru, J. Naidu, M. Shroff, R. Barrera, S. Quismundo, and V. Srivastava Use of Bilateral Internal Thoracic Arteries in CABG Through Lateral Thoracotomy With Robotic Assistance in 150 Patients Ann. Thorac. Surg., March 1, 2006; 81(3): 800 - 806. [Abstract] [Full Text] [PDF]

				Does use of a right internal thoracic artery increase deep wound infection and risk after previous use of a left internal thoracic artery? J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 609 - 613.

				J.-S. Choi, K. R. Cho, and K.-B. Kim Does Diabetes Affect the Postoperative Outcomes After Total Arterial Off-Pump Coronary Bypass Surgery in Multivessel Disease? Ann. Thorac. Surg., October 1, 2005; 80(4): 1353 - 1360. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, M. Di Mauro, G. Di Giammarco, G. Teodori, A. L. Iaco, V. Mazzei, G. Vitolla, and M. Contini Single Versus Bilateral Internal Mammary Artery for Isolated First Myocardial Revascularization in Multivessel Disease: Long-Term Clinical Results in Medically Treated Diabetic Patients Ann. Thorac. Surg., September 1, 2005; 80(3): 888 - 895. [Abstract] [Full Text] [PDF]

				J. Kobayashi, T. Tashiro, M. Ochi, H. Yaku, G. Watanabe, T. Satoh, O. Tagusari, H. Nakajima, S. Kitamura, and for the Japanese Off-Pump Coronary Revascularizati Early Outcome of a Randomized Comparison of Off-Pump and On-Pump Multiple Arterial Coronary Revascularization Circulation, August 30, 2005; 112(9_suppl): I-338 - I-343. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, G. Di Giammarco, G. Teodori, A. L. Iaco, M. Pano, M. Contini, G. Vitolla, and M. Di Mauro Bilateral internal thoracic artery grafting with and without cardiopulmonary bypass: Six-year clinical outcome J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 340 - 345. [Abstract] [Full Text] [PDF]

				S.-W. Ryu, B.-H. Ahn, S.-J. Choo, K.-J. Na, Y.-K. Ahn, M.-H. Jeong, and S.-H. Kim Skeletonized Gastroepiploic Artery as a Composite Graft for Total Arterial Revascularization Ann. Thorac. Surg., July 1, 2005; 80(1): 118 - 123. [Abstract] [Full Text] [PDF]

				P. J. Shah, K. Bui, S. Blackmore, I. Gordon, D. L. Hare, J. Fuller, S. Seevanayagam, and B. F. Buxton Has the in situ right internal thoracic artery been overlooked? An angiographic study of the radial artery, internal thoracic arteries and saphenous vein graft patencies in symptomatic patients Eur J Cardiothorac Surg, May 1, 2005; 27(5): 870 - 875. [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]

				A. M. Calafiore, L. Weltert, M. D. Mauro, G. Actis-Dato, A. L. Iaco, P. Centofanti, M. L. Torre, and F. Patane Internal mammary artery MMCTS, January 1, 2005; 2005(1129): mmcts.2004.001008 - mmcts.2004.001008. [Abstract] [Full Text] [PDF]

				M. Tabata, S. Takanashi, T. Fukui, T. Horai, T. Uchimuro, K. Kitabayashi, and Y. Hosoda Off-Pump Coronary Artery Bypass Grafting in Patients With Renal Dysfunction Ann. Thorac. Surg., December 1, 2004; 78(6): 2044 - 2049. [Abstract] [Full Text] [PDF]

				O. M. Bical, W. Khoury, Y. Fromes, M. Fischer, M. Sousa Uva, G. Boccara, and P. H. Deleuze Routine Use of Bilateral Skeletonized Internal Thoracic Artery Grafts in Middle-Aged Diabetic Patients Ann. Thorac. Surg., December 1, 2004; 78(6): 2050 - 2053. [Abstract] [Full Text] [PDF]

				F. Formica, O. Ferro, P. Greco, A. Martino, D. Gastaldi, and G. Paolini Long-term follow-up of total arterial myocardial revascularization using exclusively pedicle bilateral internal thoracic artery and right gastroepiploic artery Eur J Cardiothorac Surg, December 1, 2004; 26(6): 1141 - 1148. [Abstract] [Full Text] [PDF]

				M. A. Mariani, A. D'Alfonso, and J. G. Grandjean Total Arterial Off-Pump Coronary Surgery: Time to Change Our Habits? Ann. Thorac. Surg., November 1, 2004; 78(5): 1591 - 1597. [Abstract] [Full Text] [PDF]

				W. R. Burfeind Jr, D. D. Glower, A. S. Wechsler, R. H. Tuttle, L. K. Shaw, F. E. Harrell Jr, and J. S. Rankin Single Versus Multiple Internal Mammary Artery Grafting for Coronary Artery Bypass: 15-Year Follow-Up of a Clinical Practice Trial Circulation, September 14, 2004; 110(11_suppl_1): II-27 - II-35. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, G. Di Giammarco, G. Teodori, M. Di Mauro, A. L. IacoIaco, A. Bivona, M. Contini, and G. Vitolla Late results of first myocardial revascularization in multiple vessel disease: single versus bilateral internal mammary artery with or without saphenous vein grafts Eur J Cardiothorac Surg, September 1, 2004; 26(3): 542 - 548. [Abstract] [Full Text] [PDF]

				P. J. Shah, M. Durairaj, I. Gordon, J. Fuller, A. Rosalion, S. Seevanayagam, J. Tatoulis, and B. F. Buxton Factors affecting patency of internal thoracic artery graft: clinical and angiographic study in 1434 symptomatic patients operated between 1982 and 2002 Eur J Cardiothorac Surg, July 1, 2004; 26(1): 118 - 124. [Abstract] [Full Text] [PDF]

				L.M. Stevens, M. Carrier, L.P. Perrault, Y. Hebert, R. Cartier, D. Bouchard, A. Fortier, I. El-Hamamsy, and M. Pellerin Single versus bilateral internal thoracic artery grafts with concomitant saphenous vein grafts for multivessel coronary artery bypass grafting: Effects on mortality and event-free survival J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1408 - 1415. [Abstract] [Full Text] [PDF]

				H. Kamiya, G. Watanabe, H. Takemura, S. Tomita, H. Nagamine, and T. Kanamori Total arterial revascularization with composite skeletonized gastroepiploic artery graft in off-pump coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1151 - 1157. [Abstract] [Full Text] [PDF]

				A. Zacharias, R. H. Habib, T. A. Schwann, C. J. Riordan, S. J. Durham, and A. Shah Improved Survival With Radial Artery Versus Vein Conduits in Coronary Bypass Surgery With Left Internal Thoracic Artery to Left Anterior Descending Artery Grafting Circulation, March 30, 2004; 109(12): 1489 - 1496. [Abstract] [Full Text] [PDF]

				G. Tavilla, A. P. Kappetein, J. Braun, J. Gopie, A. T. J. Tjien, and R. A. E. Dion Long-term follow-up of coronary artery bypass grafting in three-vessel disease using exclusively pedicled bilateral internal thoracic and right gastroepiploic arteries Ann. Thorac. Surg., March 1, 2004; 77(3): 794 - 799. [Abstract] [Full Text] [PDF]

				J. Tatoulis, B. F. Buxton, and J. A. Fuller Patencies of 2,127 arterial to coronary conduits over 15 years Ann. Thorac. Surg., January 1, 2004; 77(1): 93 - 101. [Abstract] [Full Text] [PDF]

				T. Hirotani, T. Nakamichi, M. Munakata, and S. Takeuchi Risks and benefits of bilateral internal thoracic artery grafting in diabetic patients Ann. Thorac. Surg., December 1, 2003; 76(6): 2017 - 2022. [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]

				L. L. Mickleborough, S. Carson, and J. Ivanov Gender differences in quality of distal vessels: effect on results of coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 950 - 958. [Abstract] [Full Text] [PDF]

				D. Paparella, L. L. Mickleborough, S. Carson, and J. Ivanov Mild to moderate mitral regurgitation in patients undergoing coronary bypass grafting: effects on operative mortality and long-term significance Ann. Thorac. Surg., October 1, 2003; 76(4): 1094 - 1100. [Abstract] [Full Text] [PDF]

				A. Iwakura, Y. Tabata, T. Koyama, K. Doi, K. Nishimura, K. Kataoka, M. Fujita, and M. Komeda Gelatin sheet incorporating basic fibroblast growth factor enhances sternal healing after harvesting bilateral internal thoracic arteries J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 1113 - 1120. [Abstract] [Full Text] [PDF]

				M. Endo, Y. Tomizawa, and H. Nishida Bilateral Versus Unilateral Internal Mammary Revascularization in Patients With Diabetes Circulation, September 16, 2003; 108(11): 1343 - 1349. [Abstract] [Full Text] [PDF]

				C. Muneretto, G. Bisleri, A. Negri, J. Manfredi, M. Metra, S. Nodari, L. Culot, and L. Dei Cas Total Arterial Myocardial Revascularization With Composite Grafts Improves Results of Coronary Surgery in Elderly: A Prospective Randomized Comparison With Conventional Coronary Artery Bypass Surgery Circulation, September 9, 2003; 108(2011): II-29 - II-33. [Abstract] [Full Text] [PDF]

				C. Muneretto, G. Bisleri, A. Negri, J. Manfredi, M. Metra, S. Nodari, and L. Dei Cas Off-pump coronary artery bypass surgery technique for total arterial myocardial revascularization: a prospective randomized study Ann. Thorac. Surg., September 1, 2003; 76(3): 778 - 783. [Abstract] [Full Text] [PDF]

				S. K. Singh, S. K. Mishra, D. Kumar, R. D. Yadave, R. Agarwal, and S. K. Sinha Total Arterial Revascularization on Beating Heart: Experience in 803 Cases Asian Cardiovasc Thorac Ann, June 1, 2003; 11(2): 107 - 112. [Abstract] [Full Text] [PDF]

				D. Pevni, R. Mohr, O. Lev-Ran, Y. Paz, A. Kramer, I. Frolkis, and I. Shapira Technical Aspects of Composite Arterial Grafting With Double Skeletonized Internal Thoracic Arteries Chest, May 1, 2003; 123(5): 1348 - 1354. [Abstract] [Full Text] [PDF]

				C. Muneretto, A. Negri, J. Manfredi, A. Terrini, G. Rodella, S. ElQarra, and G. Bisleri Safety and usefulness of composite grafts for total arterial myocardial revascularization: A prospective randomized evaluation J. Thorac. Cardiovasc. Surg., April 1, 2003; 125(4): 826 - 835. [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]

				A. M. Calafiore, M. Di Mauro, G. Di Giammarco, M. Contini, G. Vitolla, A. Lorena Iaco, C. Canosa, and S. D'Alessandro Effect of diabetes on early and late survival after isolated first coronary bypass surgery in multivessel disease J. Thorac. Cardiovasc. Surg., January 1, 2003; 125(1): 144 - 154. [Abstract] [Full Text] [PDF]

				M J Naik, Y Abu-Omar, A Alvi, N Wright, A Henderson, K Channon, J C Forfar, and D P Taggart Total arterial revascularisation as a primary strategy for coronary artery bypass grafting Postgrad. Med. J., January 1, 2003; 79(927): 43 - 48. [Abstract] [Full Text] [PDF]

				G. Rizzoli, L. Schiavon, and P. Bellini Does the use of bilateral internal mammary artery (IMA) grafts provide incremental benefit relative to the use of a single IMA graft? A meta-analysis approach Eur J Cardiothorac Surg, November 1, 2002; 22(5): 781 - 786. [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]

				T. Hirotani, S. Shirota, Y. Cho, and S. Takeuchi Feasibility and suitability of the routine use of bilateral internal thoracic arteries Ann. Thorac. Surg., February 1, 2002; 73(2): 511 - 515. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, M. D. Mauro, S. D'Alessandro, G. Teodori, G. Vitolla, M. Contini, A. L. Iaco, and G. Spira Revascularization of the lateral wall: Long-term angiographic and clinical results of radial artery versus right internal thoracic artery grafting J. Thorac. Cardiovasc. Surg., February 1, 2002; 123(2): 225 - 231. [Abstract] [Full Text] [PDF]

				W. Stooker, H. W. M. Niessen, W. R. Wildevuur, V. W. M. van Hinsbergh, J. Fritz, E. K. Jansen, C. R. H. Wildevuur, and L. Eijsman Perivenous application of fibrin glue reduces early injury to the human saphenous vein graft wall in an ex vivo model Eur J Cardiothorac Surg, February 1, 2002; 21(2): 212 - 217. [Abstract] [Full Text] [PDF]

				J. Tatoulis, A. G. Royse, B. F. Buxton, J. A. Fuller, P. D. Skillington, J. C. Goldblatt, R. P. Brown, and M. A. Rowland The radial artery in coronary surgery: a 5-year experience--clinical and angiographic results Ann. Thorac. Surg., January 1, 2002; 73(1): 143 - 148. [Abstract] [Full Text] [PDF]

				E. Berreklouw, P. P.C. Rademakers, J. M. Koster, L. van Leur, B. J.W. van der Wielen, and P. Westers Better ischemic event-free survival after two internal thoracic artery grafts: 13 years of follow-up Ann. Thorac. Surg., November 1, 2001; 72(5): 1535 - 1541. [Abstract] [Full Text] [PDF]

				B. W. Lytle and F. D. Loop Superiority of Bilateral Internal Thoracic Artery Grafting: It's Been a Long Time Comin' Circulation, October 30, 2001; 104(18): 2152 - 2154. [Full Text] [PDF]

				M. Endo, H. Nishida, Y. Tomizawa, and H. Kasanuki Benefit of Bilateral Over Single Internal Mammary Artery Grafts for Multiple Coronary Artery Bypass Grafting Circulation, October 30, 2001; 104(18): 2164 - 2170. [Abstract] [Full Text] [PDF]

				E. Prifti, M. Bonacchi, G. Frati, P. Proietti, G. Giunti, and M. Leacche {lambda}graft with the radial artery or free left internal mammary artery anastomosed to the right internal mammary artery: flow dynamics Ann. Thorac. Surg., October 1, 2001; 72(4): 1275 - 1281. [Abstract] [Full Text] [PDF]

				O. Lev-Ran, D. Pevni, M. Matsa, Y. Paz, A. Kramer, and R. Mohr Arterial myocardial revascularization with in situ crossover right internal thoracic artery to left anterior descending artery Ann. Thorac. Surg., September 1, 2001; 72(3): 798 - 803. [Abstract] [Full Text] [PDF]

				R. Ascione, M. J. Underwood, C. T. Lloyd, J. Y. Jeremy, A. J. Bryan, and G. D. Angelini Clinical and angiographic outcome of different surgical strategies of bilateral internal mammary artery grafting Ann. Thorac. Surg., September 1, 2001; 72(3): 959 - 965. [Abstract] [Full Text] [PDF]

				H. Hirose, A. Amano, A. Takahashi, and N. Nagano Coronary artery bypass grafting for patients with non-dialysis-dependent renal dysfunction (serum creatinine greater double equals2.0 mg/dl) Eur J Cardiothorac Surg, September 1, 2001; 20(3): 565 - 572. [Abstract] [Full Text] [PDF]

				A. J. Tector, M. L. McDonald, D. C. Kress, F. X. Downey, and T. M. Schmahl Purely internal thoracic artery grafts: outcomes Ann. Thorac. Surg., August 1, 2001; 72(2): 450 - 455. [Abstract] [Full Text] [PDF]

				D. Pevni, A. Kramer, Y. Paz, O. Lev-Run, C. Locker, M. Matsa, I. Shapira, and R. Mohr Composite arterial grafting with double skeletonized internal thoracic arteries Eur J Cardiothorac Surg, August 1, 2001; 20(2): 299 - 304. [Abstract] [Full Text] [PDF]

				M. Bonacchi, E. Prifti, G. Giunti, A. Salica, G. Frati, and G. Sani Respiratory dysfunction after coronary artery bypass grafting employing bilateral internal mammary arteries: the influence of intact pleura Eur J Cardiothorac Surg, June 1, 2001; 19(6): 827 - 833. [Abstract] [Full Text] [PDF]

				M. Matsa, Y. Paz, J. Gurevitch, I. Shapira, A. Kramer, D. Pevny, and R. Mohr Bilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 668 - 674. [Abstract] [Full Text] [PDF]

				T. Markwirth, B. Hennen, B. Scheller, H.-J. Schafers, and O. Wendler Flow wire measurements after complete arterial coronary revascularization with T-grafts Ann. Thorac. Surg., March 1, 2001; 71(3): 788 - 793. [Abstract] [Full Text] [PDF]

				W. Stooker, H. W. M. Niessen, A. Baidoshvili, W. R. Wildevuur, V. W. M. Van Hinsbergh, J. Fritz, C. R. H. Wildevuur, and L. Eijsman Perivenous support reduces early changes in human vein grafts: Studies in whole blood perfused human vein segments J. Thorac. Cardiovasc. Surg., February 1, 2001; 121(2): 0290 - 297. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, M. Contini, G. Vitolla, M. Di Mauro, V. Mazzei, G. Teodori, and G. Di Giammarco Bilateral internal thoracic artery grafting: Long-term clinical and angiographic results of in situ versus Y grafts J. Thorac. Cardiovasc. Surg., November 1, 2000; 120(5): 990 - 998. [Abstract] [Full Text] [PDF]

				A. Kramer, M. Mastsa, Y. Paz, C. Locker, D. Pevni, J. Gurevitch, I. Shapira, O. Lev-Ran, and R. Mohr Bilateral skeletonized internal thoracic artery grafting in 303 patients seventy years and older J. Thorac. Cardiovasc. Surg., August 1, 2000; 120(2): 290 - 297. [Abstract] [Full Text] [PDF]

				G. Speziale, G. Ruvolo, R. Coppola, and B. Marino Intraoperative flow measurement in composite Y arterial grafts Eur J Cardiothorac Surg, May 1, 2000; 17(5): 505 - 508. [Abstract] [Full Text] [PDF]

				J.-A. Barra, E. Bezon, P. Mondine, A. Resk, M. Gilard, J. Mansourati, and J. Boshat Surgical angioplasty with exclusion of atheromatous plaques in case of diffuse disease of the left anterior descending artery: 2 years' follow-up Eur J Cardiothorac Surg, May 1, 2000; 17(5): 509 - 514. [Abstract] [Full Text] [PDF]

				R. Dion, D. Glineur, D. Derouck, R. Verhelst, P. Noirhomme, G. El Khoury, E. Degrave, and C. Hanet Long-term clinical and angiographic follow-up of sequential internal thoracic artery grafting Eur J Cardiothorac Surg, April 1, 2000; 17(4): 407 - 414. [Abstract] [Full Text] [PDF]

				J. Gurevitch, A. Kramer, C. Locker, I. Shapira, Y. Paz, M. Matsa, and R. Mohr Technical aspects of double-skeletonized internal mammary artery grafting Ann. Thorac. Surg., March 1, 2000; 69(3): 841 - 846. [Abstract] [Full Text] [PDF]

				J. Tatoulis, B. F. Buxton, J. A. Fuller, and A. G. Royse Total arterial coronary revascularization: techniques and results in 3,220 patients Ann. Thorac. Surg., December 1, 1999; 68(6): 2093 - 2099. [Abstract] [Full Text] [PDF]

				O. Wendler, B. Hennen, T. Markwirth, J. Konig, D. Tscholl, Q. Huang, E. Shahangi, H.-J. Schafers, and S. H. G. Borst T GRAFTS WITH THE RIGHT INTERNAL THORACIC ARTERY TO LEFT INTERNAL THORACIC ARTERY VERSUS THE LEFT INTERNAL THORACIC ARTERY AND RADIAL ARTERY: FLOW DYNAMICS IN THE INTERNAL THORACIC ARTERY MAIN STEM J. Thorac. Cardiovasc. Surg., November 1, 1999; 118(5): 841 - 848. [Abstract] [Full Text] [PDF]

				A. G. Royse, C. F. Royse, and J. S. Raman Exclusive Y graft operation for multivessel coronary revascularization Ann. Thorac. Surg., November 1, 1999; 68(5): 1612 - 1618. [Abstract] [Full Text] [PDF]

				K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]

				T. M. Sundt III, H. B. Barner, C. J. Camillo, and W. A. Gay Jr Total arterial revascularization with an internal thoracic artery and radial artery T graft Ann. Thorac. Surg., August 1, 1999; 68(2): 399 - 404. [Abstract] [Full Text] [PDF]

This Article Abstract Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Adrian W. Pick Thomas A. Orszulak Hartzell V. Schaff Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pick, A. W. Articles by Schaff, H. V. Search for Related Content PubMed PubMed Citation Articles by Pick, A. W. Articles by Schaff, H. V.