title: Comparison of bilateral internal thoracic artery revascularization using in situ or Y graft configurations: a prospective randomized clinical, functional, and angiographic midterm evaluation.
abstract: BACKGROUND
  Bilateral internal thoracic arteries (BITA) demonstrated superiority over other grafts to the left coronary system in terms of patency and survival benefit. Several BITA configurations are proposed for left-sided myocardial revascularization, but the ideal BITA assemblage is still unidentified.
  
  
  RESULTS
  From 03/2003 to 08/2006, 1297 consecutive patients underwent isolated bypass surgery in our institution. 481 patients met the inclusion criteria for randomization, and 304 (64%) were randomized. Patients were allocated to BITA in situ grafting (n=147) or Y configuration (n=152) then evaluated for clinical, functional, and angiographic outcome after 6 months and 3 years. Patient telephone interviews were conducted every 3 months and a stress test performed twice yearly under the referring cardiologist's supervision. Angiographic follow-up was performed 6 months after surgery. The primary and secondary end points were, respectively, major adverse cerebrocardiovascular events (MACCE) and the proportion of ITA grafts that were completely occluded at follow-up angiography. More arterial anastomoses were performed in patients randomized to the Y than the in situ configuration (3.2 versus 2.4; P<0.001). No significant difference between the 2 groups in terms of hospital mortality or morbidity was found. At follow-up, there was no significant difference in any MACCE rate between the 2 groups. 450 out of 464 anastomosis (97%) in the BITA Y group and 287 of 295 (97%) in the BITA in situ group were controlled patent (P=0.99).
  
  
  CONCLUSIONS
  Excellent patency rates were achieved using both BITA configurations with no significant differences in terms of MACCE up to 19 months postoperatively, but longer-term results remain to be established.
authors.affiliation: Service de Chirurgie cardiovasculaire et thoracique, Cliniques Universitaires Saint-Luc - U.C.L.90, Avenue Hippocrate 10/6107, 1200 Bruxelles, Belgium. david.glineur@clin.ucl.ac.be
authors.forename: David
authors.initials: D
authors.lastname: Glineur
authors.forename: Claude
authors.initials: C
authors.lastname: Hanet
authors.forename: Alain
authors.initials: A
authors.lastname: Poncelet
authors.forename: William
authors.initials: W
authors.lastname: D'hoore
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Funken
authors.forename: Jean
authors.initials: J
authors.lastname: Rubay
authors.forename: Joelle
authors.initials: J
authors.lastname: Kefer
authors.forename: Parla
authors.initials: P
authors.lastname: Astarci
authors.forename: Valerie
authors.initials: V
authors.lastname: Lacroix
authors.forename: Robert
authors.initials: R
authors.lastname: Verhelst
authors.forename: Pierre Yves
authors.initials: PY
authors.lastname: Etienne
authors.forename: Philippe
authors.initials: P
authors.lastname: Noirhomme
authors.forename: Gebrine
authors.initials: G
authors.lastname: El Khoury
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D011182:Postoperative Care; D013997:Time Factors; D014654:Vascular Patency