Department of Cardiovascular Surgery, IMS Tokyo Katsushika General Hospital, Tokyo, Japan.
Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan.
Ann Thorac Surg. 2021 Dec;112(6):1990-1996. doi: 10.1016/j.athoracsur.2021.01.015. Epub 2021 Jan 20.
The use of the left internal thoracic artery (LITA) is the gold standard in coronary artery bypass graft surgery (CABG). Multiarterial grafting for CABG is being increasingly emphasized. This study aimed to resolve the utility of the right internal thoracic artery (RITA) for multiple CABG as "free" RITA and described new evidence.
One hundred sixty-three patients received solo CABG with bilateral internal thoracic arteries between 2005 and 2018. The RITA was used as in situ RITA, group A (n = 62), and the composite graft created with saphenous vein graft (SVG), group B (n = 101). The patency rate and graft size of the composite free RITA and SVG were examined by coronary computed tomography angiography.
The average number of distal anastomoses per patient was 3.4 ± 1.0 in group A, and 4.2 ± 1.1 in group B (P < .001). The sequential grafting with free RITA was in 86 patients. The patency rate of both LITA and RITA was similar in both groups. In group B, 40 patients received late computed tomography angiography at a mean of 46 months (range, 17 to 175). The late patency rate was 95.1% in LITA and 96.9% in free RITA. The diameter of free RITA increased from 2.06 ± 0.34 mm to 2.37 ± 0.23 mm (P = .036); that of in situ LITA increased from 2.08 ± 0.51 mm to 2.44 ± 0.49 mm (P = .047); and that of composite SVG decreased from 4.1 ± 0.9 mm to 2.6 ± 0.7 mm (P < .001).
Multiple bypass grafting can be sufficiently achieved with LITA and free RITA. The growth potential of free RITA and in situ LITA might play the important role of expected long-term patency.
左内乳动脉（LITA）的使用是冠状动脉旁路移植术（CABG）的金标准。多动脉搭桥术在 CABG 中越来越受到重视。本研究旨在解决右内乳动脉（RITA）在多支 CABG 中的应用问题，并提供新的证据。
2005 年至 2018 年间，163 例患者接受了双侧内乳动脉的单纯 CABG。RITA 被用作原位 RITA（A 组，n=62）和大隐静脉移植物（SVG）的复合移植物（B 组，n=101）。通过冠状动脉计算机断层血管造影检查复合游离 RITA 和 SVG 的通畅率和移植物大小。
A 组每位患者的远端吻合口平均数量为 3.4±1.0，B 组为 4.2±1.1（P<0.001）。86 例患者采用游离 RITA 序贯搭桥。两组患者的 LITA 和 RITA 的通畅率相似。B 组 40 例患者在平均 46 个月（17 至 175 个月）时接受了晚期计算机断层血管造影检查。LITA 和游离 RITA 的晚期通畅率分别为 95.1%和 96.9%。游离 RITA 的直径从 2.06±0.34mm 增加到 2.37±0.23mm（P=0.036）；原位 LITA 的直径从 2.08±0.51mm 增加到 2.44±0.49mm（P=0.047）；复合 SVG 的直径从 4.1±0.9mm 减少到 2.6±0.7mm（P<0.001）。
LITA 和游离 RITA 可充分实现多支旁路移植术。游离 RITA 和原位 LITA 的生长潜力可能发挥预期长期通畅的重要作用。
