For the left coronary system, bilateral internal thoracic arteries (BITA) have demonstrated their superiority over all others types of grafts in terms of patency and survival benefit. Several configurations of BITA have been proposed to achieve left-sided myocardial revascularization. Because the ideal BITA assembling has not yet been found, we have prospectively randomized two types of BITA configurations to evaluate at 6 months and 3 years the clinical, functional and angiographic outcome.From 03/2003 to 08/2006, 1297 consecutive patients underwent isolated bypass surgery in our institution. Of this group, 481 patients met the entrance criteria for randomization and 304 (64%) patients were randomized. BITA grafting was performed with a pedicled configuration in 147 patients and with a Y configuration in 152. Patients were interviewed by telephone every 3 months and had a systematic stress test twice a year performed under supervision of their referring cardiologists. Systematic angiographic follow-up was performed 6 months after surgery. The primary and secondary end point was respectively the major adverse cerebro-cardiovascular events (MACCE) and the proportion of ITA grafts that were completely occluded at follow-up angiography. More arterial anastomoses were performed in patients randomized in the Y than in the pedicled configuration (3.2 versus 2.4; p< 0.001). There were no significant differences between the 2 groups in terms of hospital mortality or morbidity. Clinical follow-up is 100 % complete with a mean of 16 ± 11 months. At follow-up there is no significant difference in any MACCE rate between the 2 groups. Angiographic follow-up is 90% complete with a mean of 6.5 months. 432 out of 446 anastomosis in the BITA Y group and 278 out of 286 in the BITA pedicled group were controled patent (p=0.96).Excellent patency rates were achieved in both groups with no significant difference in terms of MACCE or patency. Whether the higher number of ITA distal anastomoses in the Y configuration group will translate in better long-term results remains to be established.
Bilateral internal thoracic artery grafting in diabetic patients: short-term and long-term results of a 515-patient series