Abstract
Introduction: The right internal thoracic artery (RITA) is occasionally used as a free graft when it does not have sufficient length to reach the target vessels. We compared the long-term clinical outcomes in propensity score-matched patients undergoing coronary artery bypass grafting (CABG), using the RITA as an in situ or free graft. Methods: From September 2004 to June 2013, 1413 patients underwent isolated CABG using the bilateral internal thoracic artery (ITA) for the revascularization of the left coronary system. Of these, 1365 patients undergoing CABG using the RITA as an in situ graft (n=878) or a free graft (n=487) were retrospectively analyzed, after excluding 48 patients in whom at least 1 ITA was used as the inflow conduit of the other graft. A total of 461 pairs were matched using propensity scores calculated from 28 preoperative variables (C statistic, 0.62). The study end-points were repeat revascularization, cardiac death, and major adverse cardiac and cerebrovascular events (MACCE). Results: The average numbers of total distal anastomoses and distal anastomoses of the RITA were significantly higher in patients undergoing free RITA grafting than in those undergoing in situ RITA grafting (4.5±1.1 versus 4.3±1.1, P=0.003 and 1.5±0.6 versus 1.1±0.2, P<0.001, respectively). In patients undergoing free RITA grafting, the RITA was used as an aortocoronary bypass graft in 68 (14.8%) and as a composite graft in 393 (85.2%) patients. There was no significant difference in the postoperative mortality and morbidity between the groups. The mean follow-up period was 4.4 years. The Kaplan-Meier estimated cumulative survival rate free from repeat revascularization, cardiac death, and MACCE at 5 years in patients undergoing in situ versus free RITA grafting, was 89.5±1.6% versus 89.9±1.6% (P=0.519), 97.3±0.9% versus 98.0±0.7% (P=0.736), and 73.7±2.3% versus 75.3±2.4% (P=0.783), respectively. Conclusions: The long-term clinical outcomes in patients undergoing free RITA grafting were comparable to those in patients undergoing in situ RITA grafting. Free RITA grafting is the effective surgical alternative to in situ RITA grafting for CABG in patients with multivessel coronary artery disease.
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