Off-pump bilateral internal thoracic artery grafting in patients with left main disease

Fukui, Toshihiro; Tabata, Minoru; Manabe, Susumu; Shimokawa, Tomoki; Shimizu, Jun; Morita, Satoshi; Takanashi, Shuichiro

doi:10.1016/j.jtcvs.2009.11.069

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 5 , Pages 1040-1045, November 2010

Off-pump bilateral internal thoracic artery grafting in patients with left main disease

Toshihiro Fukui, MD, PhD
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
- Address for reprints: Toshihiro Fukui, MD, PhD, Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu City, Tokyo 183-0003, Japan.
Minoru Tabata, MD, MPH
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
Susumu Manabe, MD, PhD
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
Tomoki Shimokawa, MD, PhD
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
Jun Shimizu, MD, PhD
- Department of Anesthesiology, Sakakibara Heart Institute, Tokyo, Japan
Satoshi Morita, MD, PhD
- Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, Yokohama, Japan
Shuichiro Takanashi, MD
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan

Received 17 September 2009; received in revised form 2 November 2009; accepted 27 November 2009. published online 02 March 2010.

Objective

This study assessed the safety and efficacy of off-pump bilateral internal thoracic artery grafting in patients with left main disease.

Methods

We reviewed the records of 768 patients who underwent off-pump bilateral internal thoracic artery grafting between September 2004 and June 2009. Bilateral internal thoracic artery grafts were used for the left coronary system in all patients, of whom 268 had left main disease and 500 did not. We compared operative and postoperative variables and early and 1-year angiographic patency rates of the bilateral internal thoracic artery between the 2 groups.

Results

The perioperative mortality and incidence of postoperative complications were not significantly different between groups. In patients without left main disease, the left and right internal thoracic arteries were used for the left anterior descending artery in 87.4% and 12.2% of patients, respectively. In patients with left main disease, the left and right internal thoracic arteries were used for the left anterior descending artery in 70.5% and 29.1% of patients, respectively. In patients with left main disease, the patency rates for the left and right internal thoracic arteries at 1-year postoperative follow-up were 97.0% and 93.2%, respectively. In patients without left main disease, the patency rates for the left and right internal thoracic arteries at 1-year follow-up were 97.6% and 91.6%, respectively. The patency rates of the left and right internal thoracic arteries did not differ significantly in patients with or without left main disease (P = .9803 and P = .7205 in left and right internal thoracic arteries, respectively).

Conclusions

Off-pump bilateral internal thoracic artery grafting was safe and effective in patients with left main disease. The patency rates of both grafts were comparable to those of patients without left main disease.

CTSNet classification: 23

Abbreviations and Acronyms: CABG, coronary artery bypass grafting, CAD, coronary artery disease, ITA, internal thoracic artery, LAD, left anterior descending, LMD, left main disease