Bilateral internal thoracic artery surgery: 17-year experience.

Abstract

Angiographic comparisons of late morphology of internal thoracic artery (ITA) and saphenous vein grafts (SVG) in the same patients established morphologic superiority of the ITA grafts (1983). 15-year clinical follow-up of 748 consecutive patients having ITA and SVGs (532) or SVGs alone (216) established the clinical advantages given to patients by ITA grafts (1986): (1) higher cumulative survival rate (P less than 0.01); (2) less early recurrence of angina (P less than 0.01); (3) fewer late myocardial infarctions (P less than 0.02); (4) lower reoperation rate (P less than 0.001). Benefits to patients having bilateral ITA grafts (38) exceeded even those of single ITA grafts: (1) operative mortality = 0%; (2) cumulative survival (10 years) = 89.0%; (3) annual recurrence of angina = 1.5%; (4) annual late myocardial infarction = 1.1%; (5) mortality rate = 0%; (6) annual reoperation rate = 0%. These data prompted routine use of bilateral ITA grafts for all patients requiring multiple bypasses, and use of each ITA for as many bypasses as seemed feasible. Since 1986, ITA anastomoses have accounted for two thirds of anastomoses in all patients requiring multiple bypasses (average 3.2 anastomoses/patient). Results have been gratifying. Potential technical pitfalls are emphasized, and means of avoiding them described.