title: Retroaortic right internal thoracic artery grafting of circumflex artery targets.
abstract: BACKGROUND
  Retroaortic right internal thoracic artery grafting has failed to gain popularity. We aimed to delineate patient correlates of eligibility, distribution of targets, and effects of target remoteness on outcome and risk of retroaortic bleeding.
  
  
  METHODS
  Data of 861 patients undergoing skeletonized bilateral internal thoracic artery grafting (2007-2012) were analyzed according to retroaortic (n = 300) or T-graft configuration. Retroaortic graft subgroups were categorized according to proximal (first obtuse marginal, ramus) or distal (2nd, 3rd, or sequential 1st-2nd obtuse marginal) circumflex artery targets.
  
  
  RESULTS
  LOESS curve analyses revealed that taller patients had a higher likelihood of retroaortic grafting. The distribution of 337 retroaortic graft targets (300 patients) was first obtuse marginal in 74.5%, 2nd marginal in 12.4%, ramus in 11.2%, 3rd marginal in 1.9% and sequential 1st-2nd marginal in 12.3%. The success rate in reaching proximal and distal circumflex artery targets was 97% and 30%, respectively, 5-year survival (92.2%) and freedom from major adverse cardiac and cerebrovascular events (85.8%) were comparable between proximal and distal retroaortic graft subgroups. Distal circumflex artery targets had no effect on the occurrence of major adverse cardiac and cerebrovascular events. The incidence of retroaortic bleeding from skeletonized retroaortic grafts was 0.6%.
  
  
  CONCLUSIONS
  Taller patients have a greater likelihood of qualifying for retroaortic grafting. This technique is highly reproducible for proximal but not distal circumflex artery targets. Distal circumflex artery targets are not independent correlates of early or late adverse outcomes. The risk of retroaortic bleeding is low despite retroaortic right internal thoracic artery skeletonization.
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel orenlevran@hotmail.com.
authors.forename: Oren
authors.initials: O
authors.lastname: Lev-Ran
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Menachem
authors.initials: M
authors.lastname: Matsa
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Ishay
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Shabtai
authors.affiliation: Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Alina
authors.initials: A
authors.lastname: Vodonos
authors.affiliation: Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Gideon
authors.initials: G
authors.lastname: Sahar
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006334:Heart Function Tests; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods* / Q000401:mortality; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Internal mammary-coronary artery anastomosis; coronary artery bypass; coronary artery disease; mammary arteries; thoracic arteries; treatment outcome