How to Use the Left Internal Thoracic Artery Which Has Been Damaged During Harvesting?

Mid‐Term Patency of the Inverted Left Internal Thoracic Artery Conduit

“…All four patients (males, mean age 67.5 ± 5.8 years) presented with moderately impaired left ventricular function and triple vessel disease, including severely stenosed or occluded LADs. This included one case of an accidental damage of the proximal LITA during harvesting, as well as one case where we intentionally divided the LITA near its origin to avoid compressions of the LITA in a patient with grossly emphysematous lung . Since hemodynamically significant flow steal and consequent myocardial ischemia have been reported during hemodialysis in patients with an upper extremity arteriovenous fistula when the ipsilateral ITA is used to bypass coronary arteries, we used the reversed LITA in our third patient on chronic hemodialysis.…”

“…mean flow from the inverted LITA conduits was 85.0 AE 14.7 mL/min (range, 70 to 105 mL/min). The 64-slice multidetector row computed tomographic (MDCT) scans performed postoperatively (range, 6 to 40 days) demonstrated all inverted LITA conduits with thrombolysis in myocardial infarction (TIMI) 3 flow,5 supplied by retrograde flow from the superior epigastric and musculophrenic arteries [1][2][3]. Follow-up MDCT scans were performed in all patients at a mean period of 25.5 AE 7.3 months (range, 18 to 35 months) after surgery, and TIMI 3 flow of all inverted LITA conduits was confirmed (Figs.…”

Distal in situ pedicled (nonskeletonized) internal thoracic artery graft

“…3 The proximal, in situ (with the origin of the ITA still ''in its original place''), nonskeletonized LITA was used to revascularize the large diagonal branch in a classic fashion, and the distal, in situ (with the branching of the ITA and the superior epigastric and musculophrenic arteries still ''in their original places''), nonskeletonized LITA revascularized the LAD in a retrograde fashion. 3 Furthermore, we have reported a case of accidental damage of the proximal LITA during harvesting 4 and intentionally division of the LITA near its origin to avoid all complications to which the classically routed nonskeletonized LITA conduit would be exposed in a patient with a grossly emphysematous lung. 5 Although in both cases, 4,5 the proximal LITA connections were divided from the subclavian artery, according to Toeg and Rubens, 1 we should have termed them free grafts, but, obviously, they are not.…”

“…3 Furthermore, we have reported a case of accidental damage of the proximal LITA during harvesting 4 and intentionally division of the LITA near its origin to avoid all complications to which the classically routed nonskeletonized LITA conduit would be exposed in a patient with a grossly emphysematous lung. 5 Although in both cases, 4,5 the proximal LITA connections were divided from the subclavian artery, according to Toeg and Rubens, 1 we should have termed them free grafts, but, obviously, they are not. Therefore, I would suggest, if anyone at all would like to change the present nomenclature, to use the term ''distal in situ nonskeletonized ITA'' for reversed ITA conduits, instead of ''free ITA graft,'' as called by Toeg and Rubens.…”

Reply to the Editor

“…Furthermore, all RV performance parameters remained impaired in patients relative to control subjects 9 months postoperatively. For the convenience of Journal readers, we would like to mention that a comparison of their TAPSE and S 0 data with available TAPSE and S 0 normal values and z scores 4,5 would have improved the statistical power of their analysis.…”