Comparison of Bilateral Internal Thoracic Artery Revascularization Using In Situ or Y Graft Configurations

Abstract

Background-Bilateral internal thoracic arteries (BITA) demonstrated superiority over other grafts to the left coronary system in terms of patency and survival benefit. Several BITA configurations are proposed for left-sided myocardial revascularization, but the ideal BITA assemblage is still unidentified. Methods and Results-From 03/2003 to 08/2006, 1297 consecutive patients underwent isolated bypass surgery in our institution. 481 patients met the inclusion criteria for randomization, and 304 (64%) were randomized. Patients were allocated to BITA in situ grafting (nϭ147) or Y configuration (nϭ152) then evaluated for clinical, functional, and angiographic outcome after 6 months and 3 years. Patient telephone interviews were conducted every 3 months and a stress test performed twice yearly under the referring cardiologist's supervision. Angiographic follow-up was performed 6 months after surgery. The primary and secondary end points were, respectively, major adverse cerebrocardiovascular events (MACCE) and the proportion of ITA grafts that were completely occluded at follow-up angiography. More arterial anastomoses were performed in patients randomized to the Y than the in situ configuration (3.2 versus 2.4; PϽ0.001). No significant difference between the 2 groups in terms of hospital mortality or morbidity was found. At follow-up, there was no significant difference in any MACCE rate between the 2 groups. 450 out of 464 anastomosis (97%) in the BITA Y group and 287 of 295 (97%) in the BITA in situ group were controlled patent (Pϭ0.99). Conclusion-Excellent patency rates were achieved using both BITA configurations with no significant differences in terms of MACCE up to 19 months postoperatively, but longer-term results remain to be established.

The right internal thoracic artery

“…Current randomized series comparing conventional LITA þ SVG versus RITA/ BITA and other grafts reinforce these findings [19,20 ]. These excellent perioperative results counter possible perceptions of myocardial hypoperfusion when two ITAs are used.…”

Are Surgical Trials with Negative Results Being Interpreted Correctly?

“…The data on the 8 trials 11-18 that met our criteria of low a priori power (<0.9), although finding no significant difference between treatment groups, are provided in Table 2. Seven of these trials reported a power ≥ 0.8 and the other a power of 0.7.…”

Meta-analysis on the use of the Heartstring anastomotic device to prevent stroke in patients undergoing off-pump coronary artery bypass grafting

“…Thus, they were herein defined as having normal ascending aorta in absence of marked of atherosclerosis changes. an alternative technique, adequate myocardial revascularization along with avoidance of manipulation of the aorta can be successfully accomplished by using one or both internal mammary arteries and using T-graft configurations [23] ( Fig. 4).…”