Comparative analysis of the patency of the internal thoracic artery in the CABG of left anterior descending artery: 6-month postoperative coronary CT angiography evaluation

Abstract

Objective To assess the patency of the pedicled right internal thoracic artery with an anteroaortic course and compare it to the patency of the left internal thoracic artery , in anastomosis to the left anterior descending artery in coronary artery bypass grafting by using coronary CT angiography at 6 months postoperatively. Methods Between December 2008 and December 2011, 100 patients were selected to undergo a prospective coronary artery bypass grafting procedure without cardiopulmonary bypass. The patients were randomly divided by a computer-generated list into Group-1 (G-1) and Group-2 (G-2), comprising 50 patients each, the technique used was known at the beginning of the surgery. In G-1, coronary artery bypass grafting was performed using the left internal thoracic artery for the left anterior descending and the free right internal thoracic artery for the circumflex, and in G-2, coronary artery bypass grafting was performed using the right internal thoracic artery pedicled to the left anterior descending and the left internal thoracic artery pedicled to the circumflex territory. Results The groups were similar with regard to the preoperative clinical data. A male predominance of 75.6% and 88% was observed in G-1 and G-2, respectively. Five patients migrated from G-1 to G-2 because of atheromatous disease in the ascending aorta. The average number of distal anastomoses was 3.48 (SD=0.72) in G-1 and 3.20 (SD=0.76) in G-2. Coronary CT angiography in 96 re-evaluated patients showed that all ITAs, right or left, used in situ for the left anterior descending were patent. There were no deaths in either group. Conclusion Coronary artery bypass grafting surgery involving anastomosis of the anteroaortic right internal thoracic artery to the left anterior descending artery has an outcome similar to that obtained using the left internal thoracic artery for the same coronary site.

Right Internal Thoracic Artery with an Anteroaortic Course

“…With this technique the entire left coronary system is revascularized with arterial grafts only (RITA and LITA), all in situ. To turn this surgery into a frequent treatment possible, the RITA to the anterior region of the heart needs to show the same good results as the LITA when used for its purpose, a result confirmed by a randomized study conducted by us [1]. Figure 1 shows details using the two ITAs for the territory of the left coronary artery and video 1 available from https://www.dropbox.com/s/0p2mcch5qw67clf/ Video%201%20-%20Animation%20RITA%20and%20LITA.mp4?dl=0 (animation showing the use of both ITAs for the left coronary artery).…”

“…Multislice coronary angiotomography was performed at 6 months after surgery in 96 of the 100 patients. None of the ITAs (RITA or LITA), grafted in LAD, showed occlusion or stenosis [1].…”

“…In several patients we performed four arterial anastomoses to LC artery territory, which was possibly due to the sequential anastomosis using both ITAs. This shows that with a good surgical strategy, it is possible to perform a full OPCAB using both I TA s [1]. The primary endpoint was the graft patency of ITAs used to graft the LAD, and the secondary endpoint was the occurrence of death or cardiac events such as MI, recurrent angina, and need for reoperation.…”

“…The treatment of coronary artery disease (CAD) is one of the most studied topics in medicine. Surgery for coronary artery bypass grafting (CABG) remains an excellent therapeutic option for the management of obstructive CAD, even with the development of new drugs and better results obtained with percutaneous treatment [1].…”

Evaluation of Coronary Artery Bypass by CT Coronary Angiography

“…Also, the nondynamic nature of CTA makes the assessment of competitive flow or vasospasm in the arterial graft difficult [2,4,6].…”