title: The "free" right internal thoracic artery: a versatile and durable conduit.
abstract: BACKGROUND
  Despite its potential advantages, the right internal thoracic artery (RITA) is used as a conduit in only 4% of coronary revascularizations. To broaden its application, we frequently use the RITA as a free graft. In this study, we review our experience with the RITA as an in situ and free graft.
  
  
  METHODS
  We reviewed the perioperative outcomes and angiographic patency rates of 479 consecutive patients who underwent RITA grafting between January 1987 and December 2011.
  
  
  RESULTS
  The RITA was harvested free (FRITA) in 380 patients (79%) and in situ in 99 (21%). The predominant target for the in situ RITA was the right coronary system (79%). The predominant targets for the FRITA were divided between the right (54%) and left coronary systems (46%). There was no perioperative mortality. Mean follow-up was 10 years. Perioperative complications included myocardial infarction (0.4%), sternal nonunions (0.4%), and reoperation for hemorrhage (0.6%). Coronary angiograms were performed in symptomatic patients (17%) after a median of seven years. FRITA patency rates at five, 10, and 15 years were 100%, 95%, and 95%, respectively, comparable to the left internal thoracic artery patency rates and superior to those of saphenous vein graft. Survival rates of FRITA patients at 10, 15, and 20 years were 92%, 89%, and 76%, respectively.
  
  
  CONCLUSIONS
  The FRITA graft reaches all distal coronary vessels and is associated with excellent patency and survival rates. Its application in coronary revascularization vastly expands the benefits of internal thoracic artery grafting.
authors.affiliation: Department of Surgery, Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Roland
authors.initials: R
authors.lastname: Assi
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Youssef
authors.forename: Zaid
authors.initials: Z
authors.lastname: Almarzooq
authors.forename: Yasser
authors.initials: Y
authors.lastname: Al-Raweshidy
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hashim
authors.forename: Arnar
authors.initials: A
authors.lastname: Geirsson
authors.forename: Sabet W
authors.initials: SW
authors.lastname: Hashim
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency