title: Comparison of sequential left internal thoracic artery grafting and separate left internal thoracic artery and venous grafting : A 5-year follow-up.
abstract: OBJECTIVE
  The superiority of left internal thoracic artery (LITA) grafting to the left anterior descending artery (LAD) is well established. Patency rates of 80%-90% have been reported at 10-year follow-up. However, the superiority of sequential LITA grafting has not been proven. Our aim was to compare patency rates after sequential LITA grafting to a diagonal branch and the LAD with patency rates of LITA grafting to the LAD and separate vein grafting to a diagonal branch.
  
  
  METHODS
  A total of 58 coronary artery bypass graft (CABG) patients, operated on between 01/2000 and 12/2002, underwent multi-slice computed tomography (MSCT) between 2006 and 2008. Of these patients, 29 had undergone sequential LITA grafting to a diagonal branch and to the LAD ("Sequential" Group), while in 29 the LAD and a diagonal branch were separately grafted with LITA and vein ("Separate" Group). Patencies of all anastomoses were investigated.
  
  
  RESULTS
  Mean follow-up was 1958±208 days. The patency rate of the LAD anastomosis was 100% in the Sequential Group and 93% in the Separate Group (p=0.04). The patency rate of the diagonal branch anastomosis was 100% in the Sequential Group and 89% in the Separate Group (p=0.04). Mean intraoperative flow on LITA graft was not different between groups (69±8ml/min in the Sequential Group and 68±9ml/min in the Separate Group, p=n.s.).
  
  
  CONCLUSIONS
  Patency rates of both the LAD and the diagonal branch anastomoses were higher after sequential arterial grafting compared with separate arterial and venous grafting at 5-year follow-up. This indicates that, with regard to the antero-lateral wall of the left ventricle, there is an advantage to sequential arterial grafting compared with separate arterial and venous grafting.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Clinic Essen, 45122 Essen, Germany. daniel.wendt@uk-essen.de
authors.forename: D
authors.initials: D
authors.lastname: Wendt
authors.forename: D
authors.initials: D
authors.lastname: Schmidt
authors.forename: D
authors.initials: D
authors.lastname: Wasserfuhr
authors.forename: B
authors.initials: B
authors.lastname: Osswald
authors.forename: M
authors.initials: M
authors.lastname: Thielmann
authors.forename: P
authors.initials: P
authors.lastname: Tossios
authors.forename: H
authors.initials: H
authors.lastname: Kühl
authors.forename: H
authors.initials: H
authors.lastname: Jakob
authors.forename: P
authors.initials: P
authors.lastname: Massoudy
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D008875:Middle Aged; D036542:Tomography, Spiral Computed; D014680:Veins / Q000637:transplantation*
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