Abstract
Background. The internal thoracic artery (ITA) bypass to the left anterior descending coronary
artery is of proven benefit in multigraft coronary artery bypass. Total ITA grafts,
if reoperation is averted by avoiding saphenous vein grafts (SVGs), are attractive.
The safety of the total ITA graft operation (all-ITA) is a concern. Methods. A randomized trial of multiple-ITA bypass graftings with the use of bilateral sequential
ITA without SVGs was performed. Control patients received 1 ITA plus SVG. Inclusion
criteria were those used in the Coronary Artery Surgery Study, extended to age 76
years, and any angina class, except emergent. One hundred sixty-two patients were
randomized (81 patients per group) from January 1, 1990, to December 31, 1994. Results. Baseline traits were similar as were cross-clamp times, pump times, and number of
arteries bypassed (average, 4.3 arteries). Patients who received multiple ITA grafts
had no myocardial infarctions, per reference laboratory. One patient died, and 2 patients
returned for bleeding. The ITA-SVG group had similar results. The all-ITA group experienced
successful completion in 93% of cases. Complications did not differ from control patients.
Conclusions. Early and 5-year outcomes were not different between the all-ITA group and the ITA
with SVGs group. We believe experienced surgeons can safely extend the ITA to multibypass
coronary artery bypass without use of SVG to achieve an all-ITA operation. (Surgery
2000;128:650-9.)
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Article info
Footnotes
*Supported in part by Marshfield Clinic Physician Research Funds, Marshfield Medical Research Foundation Disease Specific Restricted Funds, and the Gwen D. Sebold Award.
**Reprint requests: William O. Myers, MD, Department of Cardiovascular and Thoracic Surgery, Marshfield Clinic, 1000 North Oak Ave, Marshfield, WI 54449.
★Surgery 2000;128:650-9
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
