title: Revascularization of the right coronary artery in bilateral internal thoracic artery grafting.
abstract: BACKGROUND
  Bilateral internal thoracic artery (BITA) grafting with a composite T-graft enables right coronary artery (RCA) system revascularization with the distal end of the free right internal thoracic artery (RITA). This study compares this grafting technique to left-sided BITA grafting and RCA revascularization with the right gastroepiploic artery (RGEA) and saphenous vein grafts (SVG).
  
  
  METHODS
  From April 1996 to July 1999, 1000 consecutive patients underwent left-sided revascularization with BITA. In 231 patients RCA grafting was performed with free RITA, in 246 with RGEA, in 142 with SVG, and 381 did not receive any graft to the RCA (no-graft group).
  
  
  RESULTS
  Female gender, old age (> 70), emergency, and congestive heart failure were less prevalent in the RGEA group, and prior percutaneous transluminal coronary angioplasty was more prevalent in the no-graft group. Thirty-day mortality (3.6%, 4.9%, 2%, and 3.4% in the RITA, SVG, RGEA, and no-graft groups, respectively) and occurrence of perioperative complications (sternal infection, myocardial infarction, cerebrovascular accident, and bleeding) were similar. Overall, however, the trend was toward a higher complication rate in the RITA group (10.3%, 4.9%, 5.6%, and 7.3% respectively, p = 0.06). Midterm follow-up (40 to 78 months) showed similar 6-year survival (Kaplan-Meier) (88%, 87%, 89.5%, and 85.5%, respectively) and similar return of angina (10.8%, 6.3%, 10.6%, and 9.5%, respectively) in the four groups.
  
  
  CONCLUSIONS
  Early and midterm results in patients undergoing left-sided BITA grafting are not affected by the conduit used for RCA grafting.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Tel-Aviv Sourasky, Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. pevnid@yahoo.com
authors.forename: Dmitry
authors.initials: D
authors.lastname: Pevni
authors.forename: Gideon
authors.initials: G
authors.lastname: Uretzky
authors.forename: Paz
authors.initials: P
authors.lastname: Yosef
authors.forename: Ben Gal
authors.initials: BG
authors.lastname: Yanay
authors.forename: Itzhak
authors.initials: I
authors.lastname: Shapira
authors.forename: Nahum
authors.initials: N
authors.lastname: Nesher
authors.forename: Ron
authors.initials: R
authors.lastname: Braunshtein
authors.forename: Rephael
authors.initials: R
authors.lastname: Mohr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome