Invited commentary

Abstract

Bilateral internal thoracic artery grafting (BITA) to the left anterior descending and circumflex coronary arteries offers the best long-term survival (after 10 years) and the lowest rates of reintervention in patients undergoing coronary artery bypass grafting surgery. The best graft for the right coronary artery in patients with three-vessel disease has not been confirmed. The right gastroepiploic artery (GEA), the radial artery, saphenous vein graft (SVG), and composite radial artery or internal thoracic artery grafts are the most frequent choices. Esaki and colleagues [1Esaki J. Koshiji T. Okamoto M. Tsukashita M. Ikuno T. Sakata R. Gastroepiploic artery grafting does not improve the late outcome in patients with bilateral internal thoracic artery grafting.Ann Thorac Surg. 2007; 83: 1024-1029Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar] performed a retrospective study comparing 311 patients with three-vessel coronary artery disease who had BITA grafting to the left anterior descending and circumflex coronary arteries. The GEA was used in 99 patients. The SVG was used in 212 patients to bypass the right coronary artery. Although 7-year survival rates were excellent, no statistical difference in early and 7-year survival and freedom from cardiac events, reintervention, angina, or myocardial infarction was found between the two groups. Reasons offered by the authors for lack of improvement in the GEA group are that the long-term patency in the GEA is similar to the SVG, there are too few GEA patients, and the follow-up period is too short. I would agree that the follow-up period should be longer to make a definite decision on any distinct advantages to using the GEA. Not mentioned in the article is the incidence of suboptimal anastomoses, competition of flow, and new coronary artery lesions discovered on routine early or later coronary artery angiograms. Early correction of these causes of potential graft failure with the exception of competition of flow should improve long-term patency and outcomes, particularly in patients with all arterial coronary bypass grafts. These factors may have been helpful in obtaining the excellent early patency reported with the internal thoracic artery grafts. Gastroepiploic Artery Grafting Does Not Improve the Late Outcome in Patients With Bilateral Internal Thoracic Artery GraftingThe Annals of Thoracic SurgeryVol. 83Issue 3PreviewBilateral internal thoracic artery grafting in coronary artery bypass surgery has a better long-term outcome than single internal thoracic artery grafting. However, the efficacy of gastroepiploic artery (GEA) grafting in addition to bilateral internal thoracic artery grafting is still not well-established. Full-Text PDF