Comparison of sequential left internal thoracic artery grafting and separate left internal thoracic artery and venous grafting: A 5-year follow-up

Comparison of sequential left internal thoracic artery grafting and separate left internal thoracic artery and venous grafting A 5-year follow-up

Objectives The superiority of left internal thoracic artery (LITA) grafting to the left anterior descending artery (LAD) is well established. Patency rates of 80%–90% have been reported at 10-year follow-up. However, the superiority of sequential LITA grafting has not been proven. Our aim was to com...

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Bibliographic Details
Published in:Herz Vol. 35; no. 6; pp. 397 - 402
Main Authors: Wendt, D., Schmidt, D., Wasserfuhr, D., Osswald, B., Thielmann, M., Tossios, P., Kühl, H., Jakob, H., Massoudy, P.
Format: Journal Article
Language:English
Published: Munchen Urban and Vogel 01-09-2010
Springer Nature B.V
Subjects:
Aged
Cardiology
Combined Modality Therapy
Coronary Angiography
Coronary Artery Bypass - methods
Coronary Disease - diagnostic imaging
Coronary Disease - surgery
Coronary Restenosis - diagnostic imaging
Female
Follow-Up Studies
Humans
Image Processing, Computer-Assisted
Imaging, Three-Dimensional
Internal Mammary-Coronary Artery Anastomosis - methods
Internal Medicine
Male
Medicine
Medicine & Public Health
Middle Aged
Originalarbeit
Tomography, Spiral Computed
Veins - transplantation
Offenheitsraten
Computed tomography
Sequenzielles Arteria-mammaria-interna-Grafting
Computertomographie
Patency
Coronary artery bypass graft
Koronararterienbypass
Grafting, sequential left internal thoracic artery
Follow-up studies
Verlaufsuntersuchung
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Summary:Objectives The superiority of left internal thoracic artery (LITA) grafting to the left anterior descending artery (LAD) is well established. Patency rates of 80%–90% have been reported at 10-year follow-up. However, the superiority of sequential LITA grafting has not been proven. Our aim was to compare patency rates after sequential LITA grafting to a diagonal branch and the LAD with patency rates of LITA grafting to the LAD and separate vein grafting to a diagonal branch. Methods A total of 58 coronary artery bypass graft (CABG) patients, operated on between 01/2000 and 12/2002, underwent multi-slice computed tomography (MSCT) between 2006 and 2008. Of these patients, 29 had undergone sequential LITA grafting to a diagonal branch and to the LAD (“Sequential” Group), while in 29 the LAD and a diagonal branch were separately grafted with LITA and vein (“Separate” Group). Patencies of all anastomoses were investigated. Results Mean follow-up was 1958±208 days. The patency rate of the LAD anastomosis was 100% in the Sequential Group and 93% in the Separate Group ( p =0.04). The patency rate of the diagonal branch anastomosis was 100% in the Sequential Group and 89% in the Separate Group ( p =0.04). Mean intraoperative flow on LITA graft was not different between groups (69±8ml/min in the Sequential Group and 68±9ml/min in the Separate Group, p =n.s.). Conclusion Patency rates of both the LAD and the diagonal branch anastomoses were higher after sequential arterial grafting compared with separate arterial and venous grafting at 5-year follow-up. This indicates that, with regard to the antero-lateral wall of the left ventricle, there is an advantage to sequential arterial grafting compared with separate arterial and venous grafting.
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ISSN:0340-9937
1615-6692
DOI:10.1007/s00059-010-3368-5