| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1997;64:15
© 1997 The Society of Thoracic Surgeons
DR ALFRED J. TECTOR (Milwaukee, WI): I congratulate Dr Schmidt and her colleagues for excellent results, and Dr Schmidt for a superb presentation. I thank them for providing me a copy of their manuscript before the meeting.
Operative mortality of 1.8% and 5-year survival of 89% and 93% in group 1 and group 2 patients is very commendable. Internal thoracic artery graft patency was 92% and 91% and saphenous vein graft patency was 81.3% and 86.7% in group 1 and group 2, respectively, between 30 days and 9.5 years. Actuarial survival in group 2 patients from 5 to 9.6 years was unchanged, whereas actuarial survival decreased from 89.2 to 70.1 in group 1 patients. Schmidt and colleagues conclude that using a superior conduit to treat the right coronary artery disease is not beneficial. We all know the greatest advantage of ITA grafts is that they tend to remain free of obstruction for many years after placement.
My first question is, do you think the increased mortality in group 1 was due to failure of the right internal thoracic artery graft anastomosed to the right coronary artery?
Through the years, we have noticed that arteriosclerosis tends to develop in the right coronary artery in the vicinity of the bifurcation and into the proximal portions of the posterior descending and distal right arteries. My second question is, do you think that arteriosclerosis may have developed distal to the ITA anastomosis to the right coronary artery causing a failure of the graft?
The right internal thoracic artery often will not reach the posterior descending and distal right branches if it is left attached or in situ. My final question is, do you think grafting to the right coronary artery more distally in its branches might reduce the increased mortality seen between 5 and 9.5 years in your group 1 patients?
DR JONES: Thank you, Dr Tector, for your remarks. Those kinds of questions only come from someone experienced in using arterial grafts.
As regards your first question, the graft itself is not responsible for the increased long-term mortality rate. I think that the problem is its placement to the right coronary artery. In my own estimation an in situ right ITA graft to a right coronary is a difficult graft to position properly and may predispose to subtle technical problems. In addition, the right coronary artery is well-known for its increased rate of disease distal to whatever kinds of grafts used. In an appreciable percentage of these patients we bypassed either the posterior descending or one of the posterolateral branches of the right system, and we were talking about a system rather than a single right coronary artery. Bypassing the posterior descending is going to be clearly of less value than either the anterior descending or circumflex arteries because it only perfuses about one third of the left ventricular septum as its contribution to left ventricular function.
We cannot know the best method for accomplishing this result and have no data to examine the question. We used one of four possible methods to accomplish what I believe is the result.
Related Article
Ann. Thorac. Surg. 1997 64: 9-14.
This article has been cited by other articles:
|
|
 |
|
  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]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 |
