Is the mid-term outcome of free right internal thoracic artery with a proximal anastomosis modification inferior to in situ right internal thoracic artery?

Abstract

By modifying the proximal anastomosis of the free RITA, cardiac events may be decreased, while survival and graft patency comparable with in situ RITA can be obtained, and a significantly larger number of targets can be revascularized.

Total arterial coronary grafting: outcomes, concerns and controversies

“…Several configurations have been used to accomplish TAR of left-sided coronary system with bilateral internal mammary arteries (BIMA) only [13] . These include in situ right internal mammary artery (RIMA) to the left anterior descending (LAD) artery and the left internal mammary artery (LIMA) to circumflex marginal branches [14] [ Figure 1], routing the RIMA through the transverse sinus in a retroaortic course [15] [ Figure 2], and free RIMA grafts anastomosed proximally either to the LIMA [16] [ Figure 3] or to the ascending aorta [17] . Table 1 summarizes the pros and cons of these configurations.…”

Flowmetric Assessment of the Free Right Internal Thoracic Artery Anastomosed Proximally to a Saphenous Vein Graft to Revascularize the Left Coronary Artery System

“…Thus, the graft flow might not be affected each other, and this proximal anastomosis seemed to minimize the flow competition or steal phenomenon. A previous report about this type of anastomosis showed that the patency of one graft was not affected by the patency of the other graft 12) . Furthermore, the stenosis grade of the target vessel reportedly does not affect the patency rate of the RITA at follow-up angiography 6) .…”

“…Buxton and colleagues 17) reported that the highest RITA failure rates were associated with grafting a native coronary artery with < 60% stenosis compared with 80-100%, and with grafting the right coronary artery. In another study, good mid-term free RITA patency rates were reported using only the left circumfl ex artery with a high degree of stenosis (mean 87.1 %) 12) . In our present study, the mean fl ow in the free RITA used as an individual grafting to the target coronary artery with mild proximal stenosis was low.…”

“…Previous studies have reported excellent results using free RITA grafts [11][12][13] , although a recent study involving patients who were randomly assigned to undergo bilateral or unilateral ITA grafting in CABG showed no significant difference in 10-year mortality from any cause 14) . However, in the report, details regarding the free RITA, namely, the target coronary artery, the percentage of patients receiving a Y-composite graft, and the degree of proximal stenosis in the target vessels were unclear.…”

“…In a recent comparative study between in situ and free RITA grafts, Yoshizumi and colleagues showed that the early and midterm patency rates of the free RITA grafts were comparable to those when an in-situ RITA or in-situ LITA was anastomosed to the left anterior descending artery 12) . In the study, the authors used the proximal part of the SVG or a radial artery graft as an interposing cuff between the aortic wall and the free RITA or a foldback technique 20) was used in patients in whom the RITA was the sole aorto-coronary free graft.…”