Clinical and angiographic outcomes of bilateral internal thoracic artery revascularization: in situ versus free grafts

Yasunari Hayashi; Takeshi Shimamoto; Satoshi Numata; Yoshihiro Goto; Tatsuhiko Komiya; Hitoshi Yaku; Yasuhide Okawa; Toshiaki Ito

doi:10.1016/j.athoracsur.2024.09.012

Clinical and angiographic outcomes of bilateral internal thoracic artery revascularization: in situ versus free grafts

Ann Thorac Surg. 2024 Sep 21:S0003-4975(24)00777-X. doi: 10.1016/j.athoracsur.2024.09.012. Online ahead of print.

Authors

Yasunari Hayashi¹, Takeshi Shimamoto², Satoshi Numata³, Yoshihiro Goto⁴, Tatsuhiko Komiya², Hitoshi Yaku³, Yasuhide Okawa⁴, Toshiaki Ito⁵

Affiliations

¹ Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan. Electronic address: yhayashi.cvs@gmail.com.
² Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
³ Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
⁴ Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
⁵ Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan.

PMID: 39313088
DOI: 10.1016/j.athoracsur.2024.09.012

Abstract

Background: Bilateral internal thoracic artery (ITA) grafting is associated with improved long-term outcomes; however, the appropriate graft configuration remains controversial. We compared the long-term outcomes of different graft configurations.

Methods: Between 2009 and 2015, 1171 patients underwent isolated bilateral ITA grafting for left-sided complete revascularization at 4 Japanese cardiac surgery centers: underwent in situ left ITA to the left anterior descending artery+in situ right ITA to the left circumflex artery (LR group, n=278), in situ right ITA to the left anterior descending artery+in situ left ITA to the left circumflex artery (RL group, n=665), and in situ left ITA to the left anterior descending artery+free right ITA to the left circumflex artery (Free group, n=228). Major adverse cardiovascular events (MACE), including mortality, myocardial infarction and revascularization, and ITA patency were compared.

Results: Among the 3 groups, the Free group showed significantly lower MACE and overall mortality rates (p<0.001). Nonfatal myocardial infarction and revascularization rates showed no marked differences among the groups. A weighted analysis revealed a decreased risk of MACE and death in the Free group. No marked difference was observed in the patency of the ITA anastomosed to the left anterior descending artery. Patency of the ITA grafted to the circumflex artery in the LR group was significantly lower relative to the other groups. Using a free RITA grafted to the circumflex artery reduced the risk of graft failure.

Conclusions: The free RITA configuration for left-sided revascularization might have better long-term outcomes and significantly better patency than other grafts.