Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: Results of a randomized longitudinal trial

Abstract OBJECTIVES To compare different configurations of the bilateral internal thoracic arteries for the left coronary system and examine early and late outcomes, including mid-term graft patency. METHODS We reviewed 877 patients who underwent primary isolated coronary artery bypass grafting using in situ bilateral internal thoracic arteries [in situ right internal thoracic artery (RITA)-to-left anterior descending artery (LAD) grafting, n = 683; in situ left internal thoracic artery (LITA)-to-LAD grafting, n = 194]. We compared mid-term patency between the grafts. Propensity score matching was performed to investigate early and long-term outcomes. RESULTS The 2-year patency rate for RITA-to-LAD and LITA-to-LAD grafts were similar. Multivariate analysis revealed that RITA-to-non-LAD anastomosis (P = 0.029), postoperative length of stay (P = 0.003) and chronic obstructive pulmonary disease (P = 0.005) were associated with graft failure. After statistical adjustment, 176 propensity-matched pairs were available for comparison. RITA-to-LAD grafting enabled a more distal anastomosis. Kaplan–Meier analysis revealed that the incidences of death, repeat revascularization and myocardial infarction were significantly higher in the LITA-to-LAD group among both the unmatched and matched samples (P = 0.045 and 0.029, respectively). CONCLUSIONS The mid-term patency and outcomes of RITA-to-LAD grafting are good and reduces future cardiac event, in contrast to LITA-to-LAD grafting.

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377 Efficacy of noninvasive evaluation of left internal thoracic artery (LITA) graft patency using transthoracic pulse Doppler echocardiography (TTPDE)

European Journal of Echocardiography ◽

10.1016/s1525-2167(03)90739-6 ◽

2003 ◽

Vol 4 ◽

pp. S44

Author(s):

Y SUZUKI ◽

H KANDA ◽

T TANAKA ◽

T TAJIKA ◽

H KATAOKA ◽

...

Keyword(s):

Doppler Echocardiography ◽

Internal Thoracic Artery ◽

Graft Patency ◽

Noninvasive Evaluation ◽

Left Internal Thoracic Artery ◽

Pulse Doppler

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Mid to Long-Term Results of Circumflex Coronary Artery Revascularization With Left Internal Thoracic Artery Grafts

Japanese Heart Journal ◽

10.1536/jhj.45.23 ◽

2004 ◽

Vol 45 (1) ◽

pp. 23-30 ◽

Cited By ~ 1

Author(s):

Murat Mert ◽

Cenk Eray Yildiz ◽

Alev Arat-Ozkan ◽

Ihsan Bakir ◽

Cihat Bakay

Keyword(s):

Coronary Artery ◽

Internal Thoracic Artery ◽

Long Term Results ◽

Circumflex Coronary Artery ◽

Left Internal Thoracic Artery ◽

Coronary Artery Revascularization

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Is the Future of Coronary Arterial Revascularization a Hybrid Approach?

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000355 ◽

2017 ◽

Vol 12 (2) ◽

pp. 82-86 ◽

Cited By ~ 10

Author(s):

Vincenzo Giambruno ◽

Ahmad Hafiz ◽

Stephanie A. Fox ◽

Hugues Jeanmart ◽

Richard C. Cook ◽

...

Keyword(s):

Hospital Stay ◽

Internal Thoracic Artery ◽

Coronary Revascularization ◽

Surgical Trauma ◽

Stent Patency ◽

Left Internal Thoracic Artery ◽

The Mean ◽

Hybrid Coronary Revascularization

Objective Hybrid coronary revascularization offers and combines the advantages of both surgical and percutaneous revascularization and eliminates at the same time the disadvantages of both procedures. The objective of this study was to assess graft and stent patency at 6 months, rate of bleeding, intensive care unit and hospital stay, rate of reintervention, and long-term clinical follow-up. Methods From March 2004 to November 2015, a total of 203 patients underwent robotic-assisted minimally invasive direct coronary artery bypass graft of the left internal thoracic artery to the left anterior descending artery and PCI of a non-left anterior descending vessel in a single or two stage, at three different centers. Patients underwent 6-month angiographic follow-up. The mean ± SD clinical follow-up was 77.82 ±41.4 months. Results Successful hybrid coronary revascularization occurred in 196 of the 203 patients. One hundred forty-six patients underwent simultaneous surgical and percutaneous intervention. Nineteen patients underwent PCI before surgery, and 38 patient underwent PCI after surgery. No in-hospital mortality occurred. The mean ± SD ICU stay was 1 ± 1 days and the mean ± SD hospital stay was 5 ± 2 days. Only 13.3% of the patients required a blood transfusion. Six-month angiographic follow-up has been performed in the 95 patients, and it demonstrated a left internal thoracic artery anastomotic patency of 97.9% and stent patency of 92.6%. A total of 77.8 ± 41.4-month clinical follow-up demonstrated 95.1% survival, 92.6% freedom from angina, and 90.7% freedom from any form of coronary revascularization. Conclusions Hybrid coronary revascularization seems to be a promising and safe revascularization strategy. It provides selected patients with an alternative, functionally complete revascularization with minimal surgical trauma and good long-term clinical outcomes.

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