Korean Journal of Thoracic and Cardiovascular Surgery (Apr 2020)

Outcomes and Patency of Complex Configurations of Composite Grafts Using Bilateral Internal Thoracic Arteries

  • Beatrice Chia-Hui Shih,
  • Suryeun Chung,
  • Hakju Kim,
  • Hyoung Woo Chang,
  • Dong Jung Kim,
  • Cheong Lim,
  • Kay-Hyun Park,
  • Jun Sung Kim

DOI
https://doi.org/10.5090/kjtcs.2020.53.2.64
Journal volume & issue
Vol. 53, no. 2
pp. 64 – 72

Abstract

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Background: It is generally agreed that using a bilateral internal thoracic artery (BITA) composite graft improves long-term survival after coronary artery bypass grafting (CABG). Although the left internal thoracic artery (LITA)-based Y-composite graft is widely adopted, technical or anatomical difficulties necessitate complex configurations. We aimed to in-vestigate whether BITA configuration impacts survival or patency in patients undergoing coronary revascularization.Methods: Between January 2006 and June 2017, 1,161 patients underwent CABG at Seoul National University Bundang Hospital, where the standard technique is a LITA-based Y-composite graft with the right internal thoracic artery (RITA) sequentially anastomosed to non-left anterior descending (LAD) targets. Total of 160 patients underwent CABG using BITA with modifications. Their medical records and imaging data were reviewed retrospec-tively to investigate technical details, clinical outcomes, and graft patency.Results: Modifications of the typical Y-graft (group 1, n=90), LITA-based I-graft (group 2, n=39), and RITA-based composite graft (group 3, n=31) were used due to insufficient RITA length (47%), problems using LITA (28%), and target vessel anatomy (25%). The overall 30-day mortality rate was 1.9%. Among 116 patients who underwent computed tomography or conventional angiography at a mean interval of 29.9±33.1 months postoperatively, the graft patency rates were 98.7%, 95.3%, and 83.6% for the LAD, left circumflex artery, and right coronary artery territories, respectively. Patency rates for the inflow, secondary, and tertiary grafts were 98.2%, 90.5%, and 80.4%, respectively. The RITA-based graft (group 3) had the lowest patency rate of the various configurations (p<0.011).Conclusion: LITA-based Y composite graft, showed satisfactory clinical outcomes and patency whereas modifications of RITA- based composite graft had the lowest patency and 5-year survival rates. Therefore, when using RITA-based composite graft, other options should be considered before proceeding atypical configurations.

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