Surgical Experience with Bilateral Internal Thoracic Artery Grafts
Forty-two patients underwent coronary revascularization using bilateral internal thoracic artery (ITA) grafts between 1988 and 1993. A total of 116 coronary grafts were performed, or an average of 2.8 grafts per patient. Each patient received bilateral ITA grafts, and in 21 patients an additional 30 grafts were constructed with 18 autologous veins and 12 right gastroepiploic arteries. The right ITA was grafted as a free graft in 21 patients. The ITA graft patency was 94 per cent (68/72) at the time of hospital discharge. The operative morbidity included three reoperations for bleeding, one perioperative myocardial infarction, one renal failure, two postcardiotomy shock, and one colon perforation. Two hospital deaths occurred; one due to colon perforation and the other due to postcardiotomy cardiogenic shock. One patient died of cerebral infarction six months after the operation. Another patient died suddenly at home 10 months after surgery. Thirty-two patients were in New York Heart Association functional class Ⅰ, five were in class Ⅱ and one was in class Ⅲ. Cardiac functions assessed by echocardiography and scintigraphy showed significant improvement postoperatively. The actuarial survival was 91 per cent at five years for patients with bilateral ITA grafts. These data suggest that the use of bilateral ITA grafts is associated with an acceptable mortality and increases the versatility of arterial grafting.