Abstract
Objective To assess the patency of the pedicled right internal thoracic artery with an anteroaortic course and compare it to the patency of the left internal thoracic artery , in anastomosis to the left anterior descending artery in coronary artery bypass grafting by using coronary CT angiography at 6 months postoperatively. Methods Between December 2008 and December 2011, 100 patients were selected to undergo a prospective coronary artery bypass grafting procedure without cardiopulmonary bypass. The patients were randomly divided by a computer-generated list into Group-1 (G-1) and Group-2 (G-2), comprising 50 patients each, the technique used was known at the beginning of the surgery. In G-1, coronary artery bypass grafting was performed using the left internal thoracic artery for the left anterior descending and the free right internal thoracic artery for the circumflex, and in G-2, coronary artery bypass grafting was performed using the right internal thoracic artery pedicled to the left anterior descending and the left internal thoracic artery pedicled to the circumflex territory. Results The groups were similar with regard to the preoperative clinical data. A male predominance of 75.6% and 88% was observed in G-1 and G-2, respectively. Five patients migrated from G-1 to G-2 because of atheromatous disease in the ascending aorta. The average number of distal anastomoses was 3.48 (SD=0.72) in G-1 and 3.20 (SD=0.76) in G-2. Coronary CT angiography in 96 re-evaluated patients showed that all ITAs, right or left, used in situ for the left anterior descending were patent. There were no deaths in either group. Conclusion Coronary artery bypass grafting surgery involving anastomosis of the anteroaortic right internal thoracic artery to the left anterior descending artery has an outcome similar to that obtained using the left internal thoracic artery for the same coronary site.
Highlights
The treatment of coronary artery disease (CAD) is one of the most investigated issues in the medical field worldwide and the surgery for coronary artery bypass grafting (CABG) remains an excellent therapeutic option for the treatment of obstructive CAD, especially in cases where there the choice of drug or percutaneous treatment.The saphenous vein is still widely used for aortic/coronary graft, due to its ease of collection, preparation and be used for making multiple grafts
Coronary CT angiography in 96 re-evaluated patients showed that all internal thoracic artery (ITA), right or left, used in situ for the left anterior descending were patent
This research was designed presented as an assessment of 100 patients who underwent cardiac surgery for OPCAB, prospectively, randomly by computer taken before the beginning of the study and knowledge of the surgeon regarding the selected group only at the beginning of surgery, or that is, which graft would be placed in the anterior interventricular branch (AIB) territory (RITA or left internal thoracic artery (LITA)), patients did not know which technique would be used
Summary
The saphenous vein is still widely used for aortic/coronary graft, due to its ease of collection, preparation and be used for making multiple grafts. This graft may develop intimal hyperplasia and atherosclerotic lesion, showing occlusion rates of 10% to 15% in the first year after surgery; yet, after ten years only 60% of vein grafts are patent and of these only 50% are free of significant stenosis. Some authors observed that RITA performs better as a second arterial graft compared to the radial artery, especially in relation to the occurrence of cardiac events such as perioperative myocardial infarction (MI) due to vasospasm that can occur in up to 10% of patients [2]
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