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(Circulation. 2000;101:640.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Analysis by Early Angiography of Right Internal Thoracic Artery Grafting Via the Transverse Sinus

Predictors of Graft Failure

Masashi Ura, MD; Ryuzo Sakata, MD; Yoshihiro Nakayama, MD; Yoshio Arai, MD; Shuichi Oshima, MD; Katsuo Noda, MD

From the Departments of Cardiovascular Surgery and Cardiology (S.O., K.N.), Kumamoto Central Hospital, Japan.

Correspondence to Ryuzo Sakata, MD, Kumamoto Central Hospital, 96 Tainoshima, Tamukae-machi, Kumamoto City, 862-0965 Japan. E-mail masashik{at}orange.ocn.ne.jp

Background—There has been debate regarding whether technically demanding right internal thoracic artery (RITA) grafting via the transverse sinus can be extensively applied to patients in high-risk groups, such as patients with a small body size, elderly patients, and woman with relatively smaller coronary artery and internal thoracic artery (ITA) diameters.

Methods and Results—Of the 1456 patients who underwent isolated coronary artery bypass grafting between January 1989 and December 1998 at Kumamoto Central Hospital, 393 patients (mean age, 62.4±9.0 years) with the RITA anastomosed to the major branches of the circumflex artery were studied. Left ITA grafting was performed in 384 patients, and in 369, the in situ left ITA was anastomosed to the left anterior descending coronary artery using standard methods. Early postoperative angiography was performed in 381 patients. The RITA was occluded in 4 patients, and string-like artery and significant stenosis were present in 11 and 7 patients, respectively; RITA graft patency was thus 94.1%. Of the preoperative variables and angiographic data, simple and multiple logistic regression analyses identified decreased severity of native stenosis, diffuse sclerosis of native vessels, and residual side branches of the ITA as independent predictors of nonfunctional grafts. The method of ITA grafting did not influence the patency of the graft.

Conclusions—The excellent patency rate demonstrated by this study, the largest angiographic study to date of RITA grafting via the transverse sinus, indicates that this technique can provide reliable revascularization of the left ventricle and that it has the potential to be applied to a wide variety of patients with diseased circumflex arteries.

Key Words: mammary arteries • coronary artery bypass • vascular patency

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