title: Does location of the second internal thoracic artery graft influence outcome of coronary artery bypass grafting?
abstract: BACKGROUND
  We sought to determine whether location of the second internal thoracic artery (ITA) graft used for bilateral ITA grafting affects mortality and morbidity of patients with 3-system coronary artery disease and to identify factors associated with second ITA location.
  
  
  RESULTS
  From January 1972 to June 2006, 3611 patients with 3-system coronary artery disease underwent bilateral ITA grafting with one graft anastomosed to the left anterior descending system and the second to either the circumflex (n=2926) or right coronary artery (n=685) system. Follow-up was 9.2+/-7.2 years. Propensity score methodology was used to obtain risk-adjusted outcome comparisons between patients with the second ITA to circumflex versus right coronary artery. Hospital mortality (0.34% versus 0.58%; P=0.4), stroke (0.96% versus 0.88%; P=0.8), myocardial infarction (1.3% versus 0.73%; P=0.2), renal failure (0.44% versus 0.29%; P=0.6), respiratory insufficiency (3.5% versus 3.8%; P=0.7), and reoperation for bleeding (3.4% versus 3.2%; P=0.8) were similar in patients who received the second ITA to circumflex or right coronary artery and remained similar after propensity score adjustment. Late survival (86% versus 87% at 10 years) was also similar. Despite this, there was a gradual decline in ITA to right coronary artery grafting.
  
  
  CONCLUSIONS
  Contrary to prevailing wisdom that the second ITA graft should be anastomosed to the next most important left-sided coronary artery in 3-system coronary artery disease, it may be placed to either the circumflex or right coronary artery system with similar early and late outcomes.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue/Desk F24, Cleveland, OH 44195, USA. sabikj@ccf.org
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sabik
authors.forename: Aleck
authors.initials: A
authors.lastname: Stockins
authors.forename: Edward R
authors.initials: ER
authors.lastname: Nowicki
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Penny L
authors.initials: PL
authors.lastname: Houghtaling
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
authors.forename: Floyd D
authors.initials: FD
authors.lastname: Loop
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome