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

This Article Full Text Full Text (PDF) 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): Robert Dion Robert Verhelst Philippe Noirhomme Gebrine El Khoury Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dion, R. Articles by Hanet, C. Search for Related Content PubMed PubMed Citation Articles by Dion, R. Articles by Hanet, C.

Eur J Cardiothorac Surg 2000;17:407-414
© 2000 Elsevier Science NL

Long-term clinical and angiographic follow-up of sequential internal thoracic artery grafting

Cliniques Universitaires St-Luc, Avenue Hippocrate 10, B-1200 Brussels, Belgium

Corresponding author. Tel.: +31-71-526-3992; fax: +31-71-526-6965
e-mail: rdion{at}lumc.nl

Objective: Sequential internal thoracic artery (ITA) grafting allows a more complete arterial revascularization of the myocardium. We wanted to verify whether the excellent clinical and angiographic short term results reported by us before where maintained over 10 years and more. Methods: the first consecutive 500 patients having received at least one sequential ITA graft between October 1985 and August 1991 were reviewed. Age averaged 61 years. Fifty-three patients had a left ventricular ejection fraction less than 40%, 117 were not elective, 35 (7%) were reoperations, 56 (11%) had diabetes. In total 2156 anastomoses were constructed (4.3/patient), among them 1367 arterial anastomoses (2.7/patient) and 1150 sequential ITA anastomoses (2.3/patient). The clinical follow-up was 97.4% complete and averaged 9.6 (range 8.6–13.6) years. One hundred and sixty-one patients consented to a late angiographic restudy after a mean interval of 7.4 (range 1–12.2) years. Results: At 5 and 10 years, 89 and 72% of the patients were still alive. At 10 years 82% are still asymptomatic and 71% free of any type of ischaemia. Only four patients (0.8%) needed a repeat surgical revascularization, and 11 (2.3%) a percutaneous coronary angioplasty. At 5 and 10 years, 92.8 and 69% of the patients remained free of any cardiac event. Overall, 95.5% of the arterial anastomoses were patent and 96.1% of the sequential ITA were patent. There was a significant difference between the patency rate of pedicled ITA and free ITA anastomoses: 96.3 vs. 86.5% (P=0.02). There was no difference in patency between left ITA and right ITA anastomoses for the LAD and Cx areas. Sequential ITA anastomoses showed excellent patency rates to all coronary vessels but the very distal circumflex and the distal branches of right coronary artery (85%). There was no significant difference between the patency of the proximal and the distal sequential ITA anastomoses. The sequential anastomoses constructed in the length tend to remain more patent than the diamond-shaped ones: 97.2 vs. 91.5% (P=0.004). Conclusions: Sequential ITA grafting optimizes arterial revascularization. The long-term patency is excellent, is identical to that of single ITA grafting, and appears not much different from postoperative patency. The need for repeat surgical and interventional revascularization has been extremely low: 3.1% over the whole follow-up.

Key Words: Coronary surgery • Sequential grafting • Internal thoracic artery • Angiographic patency • Long-term follow-up

This article has been cited by other articles:

				T. A. Schwann, A. Zacharias, C. J. Riordan, S. J. Durham, A. S. Shah, and R. H. Habib Sequential radial artery grafts for multivessel coronary artery bypass graft surgery: 10-year survival and angiography results. Ann. Thorac. Surg., July 1, 2009; 88(1): 31 - 39. [Abstract] [Full Text] [PDF]

				A. A. Korkmaz, B. Onan, S. Onan, A. Ozkara, M. Guden, and C. Bakay Combined Internal Mammary Artery Graft in Coronary Bypass: 18-Year Follow-Up. Ann. Thorac. Surg., June 1, 2009; 87(6): e57 - e58. [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]

				M. Kawamura, H. Nakajima, J. Kobayashi, T. Funatsu, Y. Otsuka, T. Yagihara, and S. Kitamura Patency rate of the internal thoracic artery to the left anterior descending artery bypass is reduced by competitive flow from the concomitant saphenous vein graft in the left coronary artery Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 833 - 838. [Abstract] [Full Text] [PDF]

				H. B. Barner Operative Treatment of Coronary Atherosclerosis Ann. Thorac. Surg., April 1, 2008; 85(4): 1473 - 1482. [Abstract] [Full Text] [PDF]

				E. Gongora and T. M. Sundt III Myocardial Revascularization with Cardiopulmonary Bypass Card. Surg. Adult, January 1, 2008; 3(2008): 599 - 632. [Full Text]

				H. Nakajima, J. Kobayashi, T. Funatsu, Y. Shimahara, M. Kawamura, A. Kawamura, T. Yagihara, and S. Kitamura Predictive factors for the intermediate-term patency of arterial grafts in aorta no-touch off-pump coronary revascularization Eur. J. Cardiothorac. Surg., November 1, 2007; 32(5): 711 - 717. [Abstract] [Full Text] [PDF]

				P. A.R. Hayward and B. F. Buxton Contemporary Coronary Graft Patency: 5-Year Observational Data From a Randomized Trial of Conduits Ann. Thorac. Surg., September 1, 2007; 84(3): 795 - 799. [Abstract] [Full Text] [PDF]

				P. A.R. Hayward, D. L. Hare, I. Gordon, G. Matalanis, and B. F. Buxton Which Arterial Conduit? Radial Artery Versus Free Right Internal Thoracic Artery: Six-Year Clinical Results of a Randomized Controlled Trial Ann. Thorac. Surg., August 1, 2007; 84(2): 493 - 497. [Abstract] [Full Text] [PDF]

				D. Glineur, A. Poncelet, G. E. Khoury, W. D'hoore, P. Astarci, F. Zech, P. Noirhomme, and C. Hanet Fractional flow reserve of pedicled internal thoracic artery and saphenous vein grafts 6 months after bypass surgery Eur. J. Cardiothorac. Surg., March 1, 2007; 31(3): 376 - 381. [Abstract] [Full Text] [PDF]

				H. B. Barner Status of percutaneous coronary intervention and coronary artery bypass. Eur. J. Cardiothorac. Surg., September 1, 2006; 30(3): 419 - 424. [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]

				G. Rigatelli, M. Giordan, P. Cardaioli, L. Roncon, G. Faggian, G. Rigatelli, and P. Zonzin Subclavian artery angioplasty allows for implantation of the in situ internal thoracic artery graft in patients scheduled for surgical myocardial revascularization J. Thorac. Cardiovasc. Surg., June 1, 2006; 131(6): e9 - e10. [Full Text] [PDF]

				K. R. Cho, J.-S. Kim, J.-S. Choi, and K.-B. Kim Serial angiographic follow-up of grafts one year and five years after coronary artery bypass surgery. Eur. J. Cardiothorac. Surg., April 1, 2006; 29(4): 511 - 516. [Abstract] [Full Text] [PDF]

				P.-E. Falcoz, S. Chocron, C. Binquet, L. Stoica, D. Kaili, C. Quantin, and J.-P. Etievent Revascularization of the Right Coronary Artery: Grafting or Percutaneous Coronary Intervention? Ann. Thorac. Surg., April 1, 2005; 79(4): 1232 - 1239. [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. Lemma, A. Mangini, G. Gelpi, A. Innorta, A. Spina, and C. Antona Is it better to use the radial artery as a composite graft? Clinical and angiographic results of aorto-coronary versus Y-graft Eur. J. Cardiothorac. Surg., July 1, 2004; 26(1): 110 - 117. [Abstract] [Full Text] [PDF]

				O. Lev-Ran, R. Braunstein, N. Nesher, Y. Ben-Gal, G. Bolotin, and G. Uretzky Bilateral versus single internal thoracic artery grafting in oral-treated diabetic subsets: comparative seven-year outcome analysis Ann. Thorac. Surg., June 1, 2004; 77(6): 2039 - 2045. [Abstract] [Full Text] [PDF]

				O. Lev-Ran, R. Mohr, D. Pevni, N. Nesher, Y. Weissman, D. Loberman, and G. Uretzky Bilateral internal thoracic artery grafting in diabetic patients: Short-term and long-term results of a 515-patient series J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1145 - 1150. [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]

				H. S. Maniar, H. B. Barner, M. S. Bailey, S. M. Prasad, M. R. Moon, M. K. Pasque, M. L. Lester, W. A. Gay, and R. J. Damiano Radial artery patency: are aortocoronary conduits superior to composite grafting? Ann. Thorac. Surg., November 1, 2003; 76(5): 1498 - 1504. [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]

				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]

				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]

				S. Marasco and D. Esmore A novel method for performing sequential grafts with the radial artery Ann. Thorac. Surg., October 1, 2002; 74(4): 1262 - 1263. [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]

				D P Taggart Bilateral internal mammary artery grafting: are BIMA better? Heart, July 1, 2002; 88(1): 7 - 9. [Full Text] [PDF]

				Y. Takami and H. Ina Effects of skeletonization on intraoperative flow and anastomosis diameter of internal thoracic arteries in coronary artery bypass grafting Ann. Thorac. Surg., May 1, 2002; 73(5): 1441 - 1445. [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]

				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]

				R. Dion, D. Glineur, D. Derouck, R. Verhelst, P. Noirhomme, G. El Khoury, E. Degrave, and C. Hanet Complementary saphenous grafting: Long-term follow-up J. Thorac. Cardiovasc. Surg., August 1, 2001; 122(2): 296 - 304. [Abstract] [Full Text] [PDF]