title: Impact of sequential grafting of the internal thoracic or right gastroepiploic arteries on multiple coronary revascularization.
abstract: OBJECTIVE
  The aim of the study is to clarify the efficacy of the sequential anastomotic technique of the arterial conduits for multiple coronary revascularization.
  
  
  BACKGROUND
  The internal thoracic artery (ITA) is now widely accepted as a durable conduit for myocardial revascularization. The right gastroepiploic artery (GEA) has been developed as a third in situ arterial graft with an outcome similar to that of the ITA.
  
  
  METHODS
  One hundred and forty five consecutive patients (116 male, 29 female, mean age 60.4yr) who received sequential grafting of either the ITA or GEA or both were retrospectively analysed.
  
  
  RESULTS
  Sequential anastomoses were performed in 121 in situ left ITAs, 36 in situ GEAs and 12 composite right ITAs. No in situ right ITA was anastomosed sequentially. Two to six vessels (mean 3.8) were revascularized for each patient. Of the total 543 bypassed vessels, 432 (79.6%) were reconstructed with the arterial grafts. In 85 patients with quadruple bypass or more, the arterial grafts were able to reconstruct 266 out of 360 (74.0%) target vessels. Seventy one patients (49.0%) were revascularized without venous grafts. The arterial grafts could revascularize 293 out of 310 vessels (94.5%) in the LAD approximately Diagonal region, 83 out of 113 (73.4%) in the distal RCA or Cx region. There were no cardiac events responsible for the arterial grafts in the follow up period.
  
  
  CONCLUSIONS
  In light of our experience, multiple revascularization with in situ arterial sequential grafts is feasible. Aggressive application of this technique provides patients requiring multiple coronary revascularization with favorable long-term results.
authors.affiliation: Department of Surgery II, Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, 113-8603, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Ochi
authors.forename: K
authors.initials: K
authors.lastname: Yamada
authors.forename: Y
authors.initials: Y
authors.lastname: Ishii
authors.forename: H
authors.initials: H
authors.lastname: Ogasawara
authors.forename: M
authors.initials: M
authors.lastname: Fujii
authors.forename: T
authors.initials: T
authors.lastname: Yajima
authors.forename: S
authors.initials: S
authors.lastname: Kanno
authors.forename: S
authors.initials: S
authors.lastname: Tanaka
mesh_terms: D000005:Abdomen / Q000098:blood supply*; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013895:Thoracic Arteries / Q000637:transplantation*