title: Exclusive internal thoracic artery grafting in triple-vessel-disease patients: angiographic control.
abstract: 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%).
authors.affiliation: Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France. azmoun@yahoo.com
authors.forename: Alexandre
authors.initials: A
authors.lastname: Azmoun
authors.forename: Ramzi
authors.initials: R
authors.lastname: Ramadan
authors.forename: Nawwar
authors.initials: N
authors.lastname: Al-Attar
authors.forename: Chokri
authors.initials: C
authors.lastname: Kortas
authors.forename: Said
authors.initials: S
authors.lastname: Ghostine
authors.forename: Christophe
authors.initials: C
authors.lastname: Caussin
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Bourachot
authors.forename: Bernard
authors.initials: B
authors.lastname: Lancelin
authors.forename: Michel
authors.initials: M
authors.lastname: Slama
authors.forename: Remi
authors.initials: R
authors.lastname: Nottin
mesh_terms: 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