Five-year experience with sequential internal thoracic artery grafts

Aims: Five-year experience and mid-term results with extensive use of sequential LITA grafts to the LAD territory is presented.

Patients and methods: Between 1996 and 2000, 438 patients (average age 59.7±9.7 years) underwent revascularisation of the LAD territory using sequential LITA grafts. 11% of the patients required urgent revascularisation for unstable angina and 9% had poor LV function. 399 patients underwent isolated CABG and 39 had various additional procedures. A total of 1767 peripheral anastomoses were constructed (LITA: 884; RITA: 23; radial artery: 212 and saphenous vein: 648).

Results: The hospital mortality was 2.3% (3 cardiac and 7 non cardiac deaths) and there were 9 perioperative myocardial infarctions (2%). The follow up was 96.5% at 4.5±1.3 years. The late mortality was 6.5% (8 cardiac and 20 non cardiac deaths). All symptomatic patients (51 cases) underwent re-coronarography 36.7±19.7 months after surgery. A total of 232 peripheral anastomoses were restudied. The patency rate was 96% for LITA, 100% for RITA, 69% for radial artery and 74% for saphenous vein grafts. Altogether 12 patients required reintervention (11 PTCA and 1 redo revascularisation). The actuarial freedom from reintervention was 96.3% at five years.

Conclusion: The LITA can be safely used as a sequential graft to the LAD territory with reproducible mid-term results. It is especially useful in young patients requiring total arterial revascularisation.