Internal Thoracic Artery vs. Vein Grafts - Postoperative Angiographic Findings in Symptomatic Patients after 1000 Days

Abstract

Background: Superior patency-rate of ITA, especially BITA-grafting to saphenous vein grafts, is conclusive. This study evaluates angiographic findings postoperatively in 663 symptomatic patients receiving one or both ITAs and vein grafts. Methods: 663 patients (553 male, mean age 62) with CABG operated between 1/94 and 6/02 underwent reangiography due to reappearance of angina or unclear cardiac symptoms. Angiographic data were compared for patency rate of single ITA (n = 379), bilateral ITA (n = 220) or vein grafts. Recatherization was performed after an average of 1000 days (± 766 days). Severe bypass stenosis or occlusion was related to target vessels for all grafts. Results: 2099 Bypasses were performed in 663 patients. Severe stenosis or occlusion was detected in 255 ACB (19.9 %) of 1280 and 93 ITAs of 819 (11.4 %, p < 0.001). Patency was 88.8 % (532) for LITA, 88.2 % (194) for RITA. Target vessels were as follows: LITA: 60 % (358) LAD, 23.5 % (141) CX, RITA: 82 % (180) LAD. Occlusion rate for LITA was as follows: to LAD 7 %, to DIA 8.7 %, to CX 8.5 %. Occlusion rate for RITA as follows: to LAD 6.7 %, to DIA 16.7 %, to CX 0, to RCA 14.3 %. Occlusion rate for ACB was as follows: to LAD 18.7 %, to DIA 12.6 %, to CX 14.1 %, to RCA 16.1 %. Despite symptoms, bypass patency was observed in 412 (62.1 %) of 663 patients. Conclusions: Superior patency of ITA, especially BITA grafting could be documented angiographically in a negative selected symptomatic population. Graft occlusion was nearly two fold higher in vein grafts. Our surgical strategy, revascularizising RITA with LAD, LITA with circumflex artery results in satisfactory mid-term graft patency.

Key words

ITA versus saphenous veins

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