Sequential use of internal thoracic artery in myocardial revascularization: mid- and long-term results of 430 patients

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.

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P2894 End-stage heart failure associated with end-stage coronary disease: long-term results after myocardial revascularization

European Heart Journal ◽

10.1016/s0195-668x(03)95672-7 ◽

2003 ◽

Vol 24 (5) ◽

pp. 555

Author(s):

N RADOVANOVIC

Keyword(s):

Heart Failure ◽

Coronary Disease ◽

Myocardial Revascularization ◽

Long Term Results ◽

End Stage Heart Failure ◽

End Stage

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Long-term results of the radial artery used for myocardial revascularization

ACC Current Journal Review ◽

10.1016/j.accreview.2003.12.067 ◽

2004 ◽

Vol 13 (2) ◽

pp. 60

Author(s):

G. Possati ◽

M. Gaudino ◽

F. Prati

Keyword(s):

Radial Artery ◽

Myocardial Revascularization ◽

Long Term Results

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Internal Thoracic Artery T-Grafting: Operative Technique and Long-Term Results

Arterial Grafting for Coronary Artery Bypass Surgery ◽

10.1007/3-540-30084-8_33 ◽

2006 ◽

pp. 253-260

Author(s):

A. J. Tector

Keyword(s):

Operative Technique ◽

Internal Thoracic Artery ◽

Long Term Results

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Coronary-coronary bypass grafting: artery or vein?

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320941689 ◽

2020 ◽

Vol 28 (6) ◽

pp. 316-321

Author(s):

Vladlen Bazylev ◽

Evgeny Rosseikin ◽

Dmitriy Tungusov ◽

Artur Mikulyak

Keyword(s):

Myocardial Revascularization ◽

Coronary Bypass ◽

Long Term Results ◽

Bypass Grafting ◽

Coronary Bypass Grafting ◽

Coronary Bypass Grafts ◽

Long Term Follow Up ◽

Observation Period

Background The method of coronary-coronary bypass grafting was described in 1987 but has not been widely used, and there are only a few studies that report good short-term and mid-term results as well as some individual cases of long-term follow-up. In our medical institution, we carried out an analysis of the long-term results of coronary-coronary bypass grafting, which are presented in this study. Methods This was a retrospective single-center study on 95 patients who underwent coronary-coronary bypass grafting as a supplement to the standard coronary bypass grafting procedure. All patients underwent angiographic assessment of the coronary bypass grafts during the long-term follow-up period. The observation period was up to 123 months. Angiographic assessment of 109 coronary-coronary grafts was carried out. Results Twelve (7.6%) arterial and 11 (19.3%) venous conduits were found to be occluded, and 8 (10.3%) arterial and 10 (31.3%) venous coronary-coronary grafts were occluded during the observation period. Conclusion Arterial coronary-coronary artery bypass grafting represents an alternative technique that allows complete myocardial revascularization.

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Long-Term Results of the RAPCO Trials

Circulation ◽

10.1161/circulationaha.119.045427 ◽

2020 ◽

Vol 142 (14) ◽

pp. 1330-1338 ◽

Cited By ~ 4

Author(s):

Brian F. Buxton ◽

Philip A. Hayward ◽

Jai Raman ◽

Simon C. Moten ◽

Alexander Rosalion ◽

...

Keyword(s):

Diabetes Mellitus ◽

Radial Artery ◽

Graft Failure ◽

Internal Thoracic Artery ◽

Patient Survival ◽

Hazard Ratio ◽

Long Term Results ◽

Survival Estimate ◽

To Receive

Background: An internal thoracic artery graft to the left anterior descending artery is standard in coronary bypass surgery, but controversy exists on the best second conduit. The RAPCO trials (Radial Artery Patency and Clinical Outcomes) were designed to compare the long-term patency of the radial artery (RA) with that of the right internal thoracic artery (RITA) and the saphenous vein (SV). Methods: In RAPCO-RITA (the RITA versus RA arm of the RAPCO trial), 394 patients <70 years of age (or <60 years of age if they had diabetes mellitus) were randomized to receive RA or free RITA graft on the second most important coronary target. In RAPCO-SV (the SV versus RA arm of the RAPCO trial), 225 patients ≥70 years of age (or ≥60 years of age if they had diabetes mellitus) were randomized to receive RA or SV graft. The primary outcome was 10-year graft failure. Long-term mortality was a nonpowered coprimary end point. The main analysis was by intention to treat. Results: In the RA versus RITA comparison, the estimated 10-year patency was 89% for RA versus 80% for free RITA (hazard ratio for graft failure, 0.45 [95% CI, 0.23–0.88]). Ten-year patient survival estimate was 90.9% in the RA arm versus 83.7% in the RITA arm (hazard ratio for mortality, 0.53 [95% CI, 0.30–0.95]). In the RA versus SV comparison, the estimated 10-year patency was 85% for the RA versus 71% for the SV (hazard ratio for graft failure, 0.40 [95% CI, 0.15–1.00]), and 10-year patient survival estimate was 72.6% for the RA group versus 65.2% for the SV group (hazard ratio for mortality, 0.76 [95% CI, 0.47–1.22]). Conclusions: The 10-year patency rate of the RA is significantly higher than that of the free RITA and better than that of the SV. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00475488.

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