Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea.
Scand Cardiovasc J. 2013 Oct;47(5):314-8. doi: 10.3109/14017431.2013.825735. Epub 2013 Aug 12.
Coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) has been proven to improve survival. Many surgeons use the composite Y-graft which is made of left ITA (LITA) and right ITA (RITA) grafts. The LITA is typically anastomosed to left anterior descending artery (LAD). However, we have used RITA for LAD instead of LITA and reviewed the patency of ITA grafts and their clinical outcomes.
We analyzed 48 patients who underwent CABG using a BITA composite Y-graft from 2002 to 2012. In 30, LITA was anastomosed to LAD (Group L). The other 18 had RITA to LAD anastomosis (Group R).
The mean age of Group R was higher than that of Group L (p = 0.009). Postoperative angiography was performed in 35 patients (73%). Two patients in Group L and none of the patients in Group R had an ITA graft failure. The incidence of ITA graft failure and new adverse cardiovascular events were not different between the two groups.
The clinical outcome of RITA to LAD anastomosis is comparable with anastomosis of LITA to LAD in CABG using BITA composite Y-grafts. This technique may be useful when longer and larger ITA grafts are needed.
采用双侧内乳动脉（BITA）的冠状动脉旁路移植术（CABG）已被证明可提高生存率。许多外科医生使用由左内乳动脉（LITA）和右内乳动脉（RITA）吻合而成的复合 Y 型移植。LITA 通常与左前降支（LAD）吻合。然而，我们使用 RITA 代替 LITA 进行 LAD 吻合，并回顾了 ITA 移植的通畅性及其临床结果。
我们分析了 2002 年至 2012 年间接受 BITA 复合 Y 型移植的 48 例 CABG 患者。其中 30 例 LITA 与 LAD 吻合（L 组）。另外 18 例患者 RITA 与 LAD 吻合（R 组）。
R 组的平均年龄高于 L 组（p = 0.009）。35 例患者（73%）进行了术后血管造影。L 组中有 2 例患者和 R 组中无一例患者出现 ITA 移植失败。两组 ITA 移植失败和新发心血管不良事件的发生率无差异。
在使用 BITA 复合 Y 型移植的 CABG 中，RITA 至 LAD 吻合的临床结果与 LITA 至 LAD 吻合相当。当需要更长和更大的 ITA 移植时，这种技术可能是有用的。
