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(Circulation. 2008;118:S216-S221.)
© 2008 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Comparison of Bilateral Internal Thoracic Artery Revascularization Using In Situ or Y Graft Configurations

A Prospective Randomized Clinical, Functional, and Angiographic Midterm Evaluation

David Glineur, MD; Claude Hanet, MD, PhD; Alain Poncelet, MD; William D'hoore, MD, PhD; Jean-Christophe Funken, MD; Jean Rubay, MD, PhD; Joelle Kefer, MD, PhD; Parla Astarci, MD; Valerie Lacroix, MD; Robert Verhelst, MD; Pierre Yves Etienne, MD; Philippe Noirhomme, MD; Gebrine El Khoury, MD

From the Department of Cardiovascular Medicine and Surgery, University of Louvain Medical School, Brussels, Belgium.

Correspondence to David Glineur, MD, Service de Chirurgie cardiovasculaire et thoracique, Cliniques Universitaires Saint-Luc - U.C.L.90, Avenue Hippocrate 10/6107, 1200 Bruxelles, Belgium. E-mail david.glineur{at}clin.ucl.ac.be

Background— Bilateral internal thoracic arteries (BITA) demonstrated superiority over other grafts to the left coronary system in terms of patency and survival benefit. Several BITA configurations are proposed for left-sided myocardial revascularization, but the ideal BITA assemblage is still unidentified.

Methods and Results— From 03/2003 to 08/2006, 1297 consecutive patients underwent isolated bypass surgery in our institution. 481 patients met the inclusion criteria for randomization, and 304 (64%) were randomized. Patients were allocated to BITA in situ grafting (n=147) or Y configuration (n=152) then evaluated for clinical, functional, and angiographic outcome after 6 months and 3 years. Patient telephone interviews were conducted every 3 months and a stress test performed twice yearly under the referring cardiologist’s supervision. Angiographic follow-up was performed 6 months after surgery. The primary and secondary end points were, respectively, major adverse cerebrocardiovascular events (MACCE) and the proportion of ITA grafts that were completely occluded at follow-up angiography. More arterial anastomoses were performed in patients randomized to the Y than the in situ configuration (3.2 versus 2.4; P<0.001). No significant difference between the 2 groups in terms of hospital mortality or morbidity was found. At follow-up, there was no significant difference in any MACCE rate between the 2 groups. 450 out of 464 anastomosis (97%) in the BITA Y group and 287 of 295 (97%) in the BITA in situ group were controlled patent (P=0.99).

Conclusion— Excellent patency rates were achieved using both BITA configurations with no significant differences in terms of MACCE up to 19 months postoperatively, but longer-term results remain to be established.

Key Words: surgery • bypass • coronary disease • internal thoracic artery