Thorac Cardiovasc Surg 2017; 65(04): 265-271
DOI: 10.1055/s-0036-1584688
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience

Andrea Perrotti
1  Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France
,
Amedeo Spina
1  Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France
,
Enrica Dorigo
1  Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France
,
Camille Durst
1  Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France
,
Djamel Kaili
1  Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France
,
Sidney Chocron
1  Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France
› Author Affiliations
Further Information

Publication History

15 March 2016

19 May 2016

Publication Date:
01 July 2016 (online)

Abstract

Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses.

Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0.3 at univariate analysis.

Results Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3–9.9 and OR: 5.4, 95% CI: 1.3–21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2–33.5), that was unfailingly due to ungraftable right coronary artery targets.

Discussion BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.