Exclusive internal thoracic artery grafting in triple-vessel-disease patients: angiographic control.
BACKGROUND
The internal thoracic artery (ITA) is considered to be the conduit of choice for coronary artery bypass grafting surgery (CABG). In triple-vessel-disease patients, CABG can be performed exclusively using both ITAs in a Y fashion with multiple sequential side-to-side coronary anastomoses. The aim of this prospective study was to evaluate by early postoperative angiographic control, the patency and particularly the quality of ITA grafts and coronary anastomoses in this configuration.


METHODS
Between October 2002 and October 2003, 92 triple-vessel-disease patients underwent CABG with this technique and consented to immediate postoperative angiographic control. The right ITA was divided at its origin and connected to the in-situ left ITA (ITA-Y anastomosis). The left ITA was anastomosed to anterior coronary arteries and the right ITA was anastomosed to lateral and inferior coronary arteries, for a total of 374 coronary anastomoses (4.1 anastomoses per patient; range, 3 to 6).


RESULTS
There was 1 hospital death by septic shock. Two patients were reoperated on for superficial wound infection. There was no postoperative myocardial infarction or stroke. On postoperative angiograms, all ITA-Y (92) and ITA-coronary anastomoses (374) were patent. Competition of flow in right ITA to the moderately stenosed right coronary artery was observed in 9 patients, and there were 4 distal ITA-coronary stenoses, both without clinical consequences.


CONCLUSIONS
In triple-vessel-disease patients, this procedure allows CABG without increasing operative risk. ITA-Y anastomoses and multiple sequential side-to-side ITA-coronary anastomoses are safe to perform and demonstrate excellent patency and quality in early postoperative angiographic control, particularly when coronary artery stenoses are significant (>70%).
Azmoun
Alexandre
A
Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France. azmoun@yahoo.com
Ramadan
Ramzi
R
Al-Attar
Nawwar
N
Kortas
Chokri
C
Ghostine
Said
S
Caussin
Christophe
C
Bourachot
Marie-Laure
ML
Lancelin
Bernard
B
Slama
Michel
M
Nottin
Remi
R
D000368:Aged; D000714:Anastomosis, Surgical; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D014654:Vascular Patency