title: All-artery multigraft coronary artery bypass grafting with only internal thoracic arteries possible and safe: a randomized trial.
abstract: BACKGROUND
  The internal thoracic artery (ITA) bypass to the left anterior descending coronary artery is of proven benefit in multigraft coronary artery bypass. Total ITA grafts, if reoperation is averted by avoiding saphenous vein grafts (SVGs), are attractive. The safety of the total ITA graft operation (all-ITA) is a concern.
  
  
  METHODS
  A randomized trial of multiple-ITA bypass graftings with the use of bilateral sequential ITA without SVGs was performed. Control patients received 1 ITA plus SVG. Inclusion criteria were those used in the Coronary Artery Surgery Study, extended to age 76 years, and any angina class, except emergent. One hundred sixty-two patients were randomized (81 patients per group) from January 1, 1990, to December 31, 1994.
  
  
  RESULTS
  Baseline traits were similar as were cross-clamp times, pump times, and number of arteries bypassed (average, 4.3 arteries). Patients who received multiple ITA grafts had no myocardial infarctions, per reference laboratory. One patient died, and 2 patients returned for bleeding. The ITA-SVG group had similar results. The all-ITA group experienced successful completion in 93% of cases. Complications did not differ from control patients.
  
  
  CONCLUSIONS
  Early and 5-year outcomes were not different between the all-ITA group and the ITA with SVGs group. We believe experienced surgeons can safely extend the ITA to multibypass coronary artery bypass without use of SVG to achieve an all-ITA operation.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Marshfield Clinic, Marshfield, WI 54449, USA.
authors.forename: W O
authors.initials: WO
authors.lastname: Myers
authors.forename: R
authors.initials: R
authors.lastname: Berg
authors.forename: J F
authors.initials: JF
authors.lastname: Ray
authors.forename: J W
authors.initials: JW
authors.lastname: Douglas-Jones
authors.forename: H S
authors.initials: HS
authors.lastname: Maki
authors.forename: R H
authors.initials: RH
authors.lastname: Ulmer
authors.forename: B R
authors.initials: BR
authors.lastname: Chaitman
authors.forename: R A
authors.initials: RA
authors.lastname: Reinhart
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods* / Q000706:statistics & numerical data*; D003326:Coronary Circulation; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality; D017534:Radial Artery; D012501:Saphenous Vein; D016019:Survival Analysis; D016896:Treatment Outcome