title: Effect of modified proximal anastomosis of the free right internal thoracic artery: piggyback and foldback techniques.
abstract: OBJECTIVE
  Few studies have reported the free right internal thoracic artery (RITA) being used in an aorto-coronary fashion. This study aimed to evaluate the free RITA with modified proximal anastomosis in an aorto-coronary fashion.
  
  
  METHODS
  Between January 2000 and December 2012, 282 patients underwent coronary artery bypass grafting with bilateral internal thoracic arteries for complete revascularization of the left coronary system at our institution. The left internal thoracic artery (LITA) was anastomosed to the left anterior descending artery (LAD) and the RITA was anastomosed to the left circumflex branches (LCX). The RITA was used as a free graft in 213 patients (free group) and as an in situ graft in 69 patients (in situ group). Proximal anastomosis of the free RITA onto the ascending aorta was performed in two different ways. We compared early and late results and graft patency of the free RITA with those of the in situ RITA retrospectively.
  
  
  RESULTS
  The numbers of anastomoses per patient and anastomoses of the RITA were larger in the free group than in the in situ group (P < 0.01). There was no significant difference in postoperative survival between the groups (free group: 93.3% vs in situ group: 90.0%, P = 0.82). The 5-year patency of the free RITA was higher than that of the in situ RITA (97.0 vs 80.3%, P = 0.01). The 5-year patency of the free RITA was comparable with that of the in situ LITA anastomosed to the LAD (97.0 vs 92.9%, P = 0.28).
  
  
  CONCLUSIONS
  The free RITA anastomosed to the LCX might have better late patency than the in situ RITA. The free RITA with modified proximal anastomosis in an aorto-coronary fashion enables complete revascularization of the left coronary system with the in situ LITA to the LAD.
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan yhayashi.cvs@gmail.com.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Maekawa
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan.
authors.forename: Sadanari
authors.initials: S
authors.lastname: Sawaki
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Tokoro
authors.affiliation: Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Yanagisawa
authors.affiliation: Clinical Study Support Center, Aichi Medical University Hospital, Yazakokarimata, Nagakute, Aichi, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Murotani
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Aorto-coronary bypass; Coronary artery bypass grafting; Right internal thoracic artery