Sequential use of internal thoracic artery in myocardial revascularization: mid- and long-term results of 430 patients(1).

Background: There is still controversy about early and late results of sequenital use of internal thoracic artery (ITA) in coronary artery bypass (CAB) operations.

Methods: In this study, we report on a series of 430 consecutive patients who underwent CAB operations between 1986 and 1998, with the use of at least one sequential ITA graft. The patients, 379 men and 51 women had a mean age of 56.4 years (range 29-80 years). Both ITA grafts were used in 227 (52.8%) patients. A total of 1744 (mean 4.05 per patient) distal coronary anastomoses were performed: 1172 of which (mean 2.72) were arterial and 980 (mean 2.28) were sequential ITA anastomoses.

Results: Thirty-day mortality was 1.8% (n=8 patients). Perioperative myocardial infarction occurred in 12 patients (2.8%) and five of them (1.2%) were confined to the sequential ITA grafted area. Follow-up ranged from 1 month to 13 years (mean 63+/-37.7 months) for 372 patients (86.5%). Nine patients died during follow-up period. According to Kaplan-Meier method, 5 and 10 year survival rates were 95.6 and 93.4%, respectively. Coronary angiography was performed in 64 patients (17.2%) after a mean of 33 months. In 31 of these patients angiography was performed due to return of symptoms. Overall patency rate of sequential ITA anastomoses was 91.7% (111/121). Two patients underwent repeat CAB operations.

Conclusion: Sequential use of ITA grafts was not associated with the increased perioperative mortality and morbidity and has the potential to improve the long-term results of CAB surgery because of excellent patency rates of sequential ITA anastomoses.